Cholecystectomy: the gold standard.

There were 14,232 patients operated on for non-malignant biliary tract disease at a single medical center from 1932 through 1984. During this period, there were 237 postoperative deaths. Of the total number of patients, 10,749 underwent cholecystectomy with 60 postoperative deaths. Cholecystostomy was performed in 599 patients with 60 deaths. Cholecystectomy or cholecystostomy in conjunction with common duct exploration was performed in 2,226 patients with 89 deaths. Choledochotomy alone as a secondary procedure to search for stones was performed in 374 patients with 21 deaths. Procedures for strictures and miscellaneous conditions were performed in 284 patients with 21 deaths. Cholecystectomy for chronic cholecystitis was performed in 8,910 patients with 38 deaths. The data from the last 6 years of this study disclosed 30 postoperative deaths; only one of these patients might have been a candidate for lithotripsy or bile acid dissolution therapy. Nonsurgical alternative therapies for gallstone disease are unlikely to decrease the mortality from calculous biliary tract disease. Furthermore, stone recurrence will continue to be the major limiting factor for those techniques that fail to remove the gallbladder.