Developing trends in acute cholecystitis and choledocholithiasis.

Among 2,347 operations performed for acute cholecystitis during a 46 year period, 1932 to 1978, choledochotomy was combined with either cholecystectomy or cholecystostomy in 364 instances. A report published for the first period, 1932 to 1955, is compared with a comparable period, 1955 to 1978. A greater number of patients were operated upon during the second period, 83 for the first 23 years and 276 for the second 23 year period. The average age increased from 49.6 to 65.3 years. The incidence of choledocholithiasis increased from 59 to 62 per cent. The ratio of females to males shifted from 4.2:1.0 for 1932 to 1955 to 1.6:1.0 for 1955 to 1978. Associated conditions recognized preoperatively increased from 2.5 per patient to 4.9 per patient. Postoperative complications increased from 27 in 83 patients, 1932 to 1955, to 250 complications in the 276 patients, 281 operations, in the second series, 1955 to 1978. The mortality increased from 2.5 to 10.9 per cent. In the past 46 years, 97 per cent of the deaths occurred in patients 50 years of age or older, with only one death, 3 per cent, occurring in a patient less than 50 years old, and this patient was operated upon in the second series, 1955 to 1978. It is suggested that the increased age and associated conditions at the time of operation for a sequelae of calculous biliary tract disease account fort the increased mortality. Undelayed cholecystectomy for cholelithiasis following the establishment of the diagnosis should prevent the sequelae of acute cholecystitis with presumed choledocholithiasis.