Among 3192 operations on the gall bladder and biliary ducts clinically and chemically a benign icterus was found in 318 patients (9.9%) (maximal serum bilirubin values 21 mumol/l). 140 patients (44%) had a typical biliary history over many years, 173 patients (54%) had only cholelithiasis, 98 patients (30.9%) had concrements in the gall bladder and biliary ducts and 9 patients (2.8%) had concrements in the biliary ducts only. In 141 patients (44.3%) additional complications were found. The post-operative mortality was 5% among which were 9 patients dying of the final stages of their basic disease or its complications; 7 patients died of cardiopulmonary complications. An improvement of the prognosis can only be reached by early operation of patients with gallstones.
Both rigid and flexible instruments can be used for endoscopic examination of the biliary tract. The approach is via the cystic duct or by means of a choledochotomy. The stump of the ductus cysticus will be useful if it is necessary to clarify a pathological finding in the distal bile duct or in the region of the papilla of Vater. Usually, however, the instrument is introduced by means of a choledochotomy. First of all, the distal region including the papilla of Vater and then the proximal part of the biliary system are closely examined. The normal biliary duct wall appears yellowish-red without showing the vascular structure. The papilla of Vater region presents a honeycomb appearance. Special emphasis in endoscopic examination is on papilla function, i.e. the opening or closing of the papilla if liquid is allowed to flow in. Results of 935 endoscopic examinations are reported.
104 patients with acute cholecystitis were divided into four groups according to the kind of pre-operative treatment received: immediate; early; late; and interval operation. Total duration of hospital stay depended on the duration of pre-operative treatment. It was shortest (24.9 days) in those operated on within the first week, longest (71.1 days) in those operated on during the interval. Evidence of severe gallbladder wall changes (macroscopic and microscopic) was obtained in two thirds of patients, even after weeks of conservative treatment. Six patients (5.7%) died postoperatively, three of them after early operation. Overall mortality was only in part due to severe complications of the gallbladder disease.
Between 1961 and 1980 442 patients with rectosigmoidal carcinoma were treated. As preparation for operation and technique changed in 1974, two groups were formed: those between 1961 and 1973 (n = 196) and those from 1974 to 1980 (n = 246). The average duration of treatment was reduced from 63 to 36 due to out-patient preoperative measures. Resection (continent and incontinent) was the standard procedure, with local transanal excision in occasional cases. Continence preserving resection increased two-fold when compared with amputation in the second period. The death rate in 337 resected tumours was 18.5% and could be reduced from 22% to 16%. The death rate unrelated to operation remained unchanged whereas the operative mortality after a curative procedure fell from 11% to 2%. The reduction in death rate directly due to the operation was particularly noticeable in the simultaneous abdomino-perineal rectal amputation. Only one out of 18 patients operated on in this way died due to massive pulmonary embolism.
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