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Should the gallbladder be removed without drainage?
78
American Journal of Surgery
Progress
in Surgery
SurgicaI intervention is frequentIy practiced. ExpIoration sometimes heIps to make a differentiaI diagnosis. Two cases of pancreatic tumors (due to simpIe inflammation) causing jaundice, with perfect recovery, one after simpIe biIiary drainage and the other after choIecystogastrostomy, deserve specia1 mention. In both the condition simuIated maIignant disease of the gaI1 bIadder or pancreas. If no operation had been done they wouId certainIy have succumbed after great suffering.
in association with biIe-duct epitheIium. Showers of cIumped crystaIs in the biIe strongIy suggest gaIIstones. By utiIizing biIiary drainage to determine the earIiest stages of biIe duct infection and inff ammation, ChoIecystography to ascertain the pathologic physioIogy and anatomy of the gaI1 bladder, and a serum biIirubin determination to gain some idea reIative to the Iiver invoIvement, the diagnosis of earIy gaI1 tract disease, suspected on the basis of cIinica1 symptoms, can be confirmed and refined.
MATEER, JOHN G., and HENDERSON, W. STUART. Chronic biIiary tract disease. Arch. Int. Med., Dec. 15, 1926, xxxviii.
WANGENSTEEN, OWEN H. ShouId the gaIIbIadder be removed without drainage? Ann. Surg., Dec., 1926, Ixxxiv.
This study is mainIy based on a detaiIed anaIysis of the diagnostic findings in ninetyfour consecutive operated patients with chronic gaI1 tract disease. Recent pathoIogica1 studies indicate that chronic gal1 tract disease invoIves not onIy a chronic ChoIecystitis but aIso a chronic interstitia1 hepatitis and a chronic choIangitis with diIatation of the larger extrahepatic biIe ducts. The reIative invoIvement of the gaI1 bladder, biIe ducts and Iiver varies greatIy in the individual case, making it desirabIe to use various methods of diagnosis to obtain information regarding the invoIvement of these three parts of the bihary tree. The history affords most vaIuabIe evidence for the presence of gal1 tract disease. It is indispensabIe to a correct functiona diagnosis and a proper evaIuation of the gastrointestina1 symptoms. This is especiaIIy important in patients who have evidence of severa pathoIogicaI conditions in the gastrointestina1 tract. The physical examination aids greatIy in the differential diagnosis from irritable coIon, chronic appendicitis, renaI disease, etc. ChoIecystography affords reIiabIe information in a high percentage of cases, and has greatIy refined gaII-bIadder diagnosis. The ora administration of the dye is unobjectionabIe, and aIso reIiabIe, if a proper and uniform technique is foIIowed. Other roentgen-ray methods are stiI1 of vaIue in a smaIIer percentage of cases, and shouId be used in conjunction with ChoIecystography. DuodenobiIiary drainage affords important direct evidence of chronic choIangitis, and vaIuabIe indirect evidence of ChoIecystitis, in the finding of biIe-stained cIumps of pus ceIIs and biIe-stained coIonies of bacteria, frequentIy
Wangensteen reports a case and experiences of others, and concIudes that the so-caIIed “idea1 choIecystectomy” is not a safe procedure. An instance of its practice in which drainage was omitted is cited, the outcome of which was favorabIe foIIowing the spontaneous escape of a Iarge quantity of biIe through the abdomina1 incision. Numerous instances are reported where reIaparotomy was necessary because of biIe Ieakage when drainage was omitted. A stiI1 greater number died because of the escape of biIe and the faiIure to drain. The Ieakage of biIe may be earIy or deIayed. That occurring soon after remova of the gaI1 bIadder is due to injury to the Iiver bed or severance of smaI1 aberrant biIe ducts. The deIayed escape of biIe is occasioned by insuffrciency of cystic duct occIusion. Drainage after choIecystectomy is imperative. It is a safeguard and does no harm. DELORE, X., MALLET-GUY, P., and BURLET, J. Late resuIts after gastric resection for carcinoma. (Suites Cloignkes de la rksection gastrique pour cancer.) Presse MCd., Oct. 6, I 926. Of 130 cases operated upon for gastric carcinoma, 88 were carefuIIy foIIowed. The authors have considered those aIive after three years as definiteIy cured. They obtained onIy 16 per cent of such cures. PracticaIIy a11 of the cases showed a period of temporary cure Iasting on an average about eighteen months. Thereafter the patients usuaIIy began to compIain of various gastric troubIes, icterus, ascites and pain, which were considered as signs of recurrence. The authors show that the occurrence of a pyloric stenosis is to be considered a favorabIe earIy sign rather than as of bad prognostic
American Journal of Surgery
Progress
in Surgery
SurgicaI intervention is frequentIy practiced. ExpIoration sometimes heIps to make a differentiaI diagnosis. Two cases of pancreatic tumors (due to simpIe inflammation) causing jaundice, with perfect recovery, one after simpIe biIiary drainage and the other after choIecystogastrostomy, deserve specia1 mention. In both the condition simuIated maIignant disease of the gaI1 bIadder or pancreas. If no operation had been done they wouId certainIy have succumbed after great suffering.
in association with biIe-duct epitheIium. Showers of cIumped crystaIs in the biIe strongIy suggest gaIIstones. By utiIizing biIiary drainage to determine the earIiest stages of biIe duct infection and inff ammation, ChoIecystography to ascertain the pathologic physioIogy and anatomy of the gaI1 bladder, and a serum biIirubin determination to gain some idea reIative to the Iiver invoIvement, the diagnosis of earIy gaI1 tract disease, suspected on the basis of cIinica1 symptoms, can be confirmed and refined.
MATEER, JOHN G., and HENDERSON, W. STUART. Chronic biIiary tract disease. Arch. Int. Med., Dec. 15, 1926, xxxviii.
WANGENSTEEN, OWEN H. ShouId the gaIIbIadder be removed without drainage? Ann. Surg., Dec., 1926, Ixxxiv.
This study is mainIy based on a detaiIed anaIysis of the diagnostic findings in ninetyfour consecutive operated patients with chronic gaI1 tract disease. Recent pathoIogica1 studies indicate that chronic gal1 tract disease invoIves not onIy a chronic ChoIecystitis but aIso a chronic interstitia1 hepatitis and a chronic choIangitis with diIatation of the larger extrahepatic biIe ducts. The reIative invoIvement of the gaI1 bladder, biIe ducts and Iiver varies greatIy in the individual case, making it desirabIe to use various methods of diagnosis to obtain information regarding the invoIvement of these three parts of the bihary tree. The history affords most vaIuabIe evidence for the presence of gal1 tract disease. It is indispensabIe to a correct functiona diagnosis and a proper evaIuation of the gastrointestina1 symptoms. This is especiaIIy important in patients who have evidence of severa pathoIogicaI conditions in the gastrointestina1 tract. The physical examination aids greatIy in the differential diagnosis from irritable coIon, chronic appendicitis, renaI disease, etc. ChoIecystography affords reIiabIe information in a high percentage of cases, and has greatIy refined gaII-bIadder diagnosis. The ora administration of the dye is unobjectionabIe, and aIso reIiabIe, if a proper and uniform technique is foIIowed. Other roentgen-ray methods are stiI1 of vaIue in a smaIIer percentage of cases, and shouId be used in conjunction with ChoIecystography. DuodenobiIiary drainage affords important direct evidence of chronic choIangitis, and vaIuabIe indirect evidence of ChoIecystitis, in the finding of biIe-stained cIumps of pus ceIIs and biIe-stained coIonies of bacteria, frequentIy
Wangensteen reports a case and experiences of others, and concIudes that the so-caIIed “idea1 choIecystectomy” is not a safe procedure. An instance of its practice in which drainage was omitted is cited, the outcome of which was favorabIe foIIowing the spontaneous escape of a Iarge quantity of biIe through the abdomina1 incision. Numerous instances are reported where reIaparotomy was necessary because of biIe Ieakage when drainage was omitted. A stiI1 greater number died because of the escape of biIe and the faiIure to drain. The Ieakage of biIe may be earIy or deIayed. That occurring soon after remova of the gaI1 bIadder is due to injury to the Iiver bed or severance of smaI1 aberrant biIe ducts. The deIayed escape of biIe is occasioned by insuffrciency of cystic duct occIusion. Drainage after choIecystectomy is imperative. It is a safeguard and does no harm. DELORE, X., MALLET-GUY, P., and BURLET, J. Late resuIts after gastric resection for carcinoma. (Suites Cloignkes de la rksection gastrique pour cancer.) Presse MCd., Oct. 6, I 926. Of 130 cases operated upon for gastric carcinoma, 88 were carefuIIy foIIowed. The authors have considered those aIive after three years as definiteIy cured. They obtained onIy 16 per cent of such cures. PracticaIIy a11 of the cases showed a period of temporary cure Iasting on an average about eighteen months. Thereafter the patients usuaIIy began to compIain of various gastric troubIes, icterus, ascites and pain, which were considered as signs of recurrence. The authors show that the occurrence of a pyloric stenosis is to be considered a favorabIe earIy sign rather than as of bad prognostic