[Surgical tactics in gangrenous and perforative cholecystitis].

Operations were conducted on 253 patients with acute cholecystitis, which was gangrenous in 84 (33.2%) and perforative in 7 patients. No relation was found between the frequency of these forms and the patients' age and duration of the disease. Quite frequently the clinical picture did not correspond to the morphological changes in the gallbladder wall. On 17 (20.23%) patients the operation was performed in the first 24 hours after hospitalization and circumscribed or generalized peritonitis was often found; 57 patients (67.85%) underwent operation on day 2-3 and infiltration was found in 24 and circumscribed peritonitis in 8 patients; in 10 cases the operation was conducted after day 3, the clinical manifestations of the disease were scarce. All were treated by cholecystectomy, postoperative complications developed in 5 (5.95%), 2 (2.38%) patients died. The authors recommend more active surgical tactics and claim that cholecystectomy in the most substantiated operation which can be practically carried out in all cases.