Surgical Problems Associated with Cholelithiasis*

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The surgical treatment of cholelithiasis naturally includes the management of cholecystitis. The etiologic factors in cholecystic disease can only be mentioned here. A vast amount of experimental work has been done on the etiology of gall stones, but this has not greatly altered the conception that there are three main factors, infection, stasis and cholesterol metabolism, which function in their causation.

In discussing this problem, Twiss and Green1 have contributed a very excellent article on the dietary and medical management of the disease. They made the pertinent statement that a tremendous amount of work has been done on different phases of cholesterol metabolism but so far there is no final agreement as to the origin, function or fate of this material. They feel that if medical therapy is ever to supplant surgery in this field of medicine, it will be necessary to recognize and to correct disturbances in the biliary tract before the calculi are formed.

One question which almost always arises in the surgeon’s mind concerns the rate of formation of these stones, and it is possible that cholecystography may lead to more complete information about this phase of the problem. I was very much interested last year while visiting a clinic of Dr. John Finney, Sr., to hear him cite the case of an elderly woman who had acute suppurative cholecystitis with stones. Her condition was such that he did not feel justified in performing cholecystectomy, but did do a cholecystostomy and removed a large number of stones. . .



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