General surgery: biliary surgery.

The management of biliary tract disease has changed completely as a result of minimally invasive treatment. For most patients with gallstones that cause symptoms a laparoscopic cholecystectomy will treat the condition with minimal morbidity and a short recovery period. If complications are encountered, conversion to a mini-cholecystectomy gives results that are nearly as good. Acute cholecystitis can be treated by percutaneous drainage followed either by percutaneous cholecystolithotomy or a laparoscopic cholecystectomy. Gallstones in the bile duct are best treated by endoscopic sphincterotomy with duct clearance. The day of the large cholecystectomy scar with its subsequent incisional hernia has gone.     

Visualization of the biliary tract; preoperative and post-operative radiologic investigation

Modern operative treatment of diseases of the bile passages requires the use of x-ray visualization of the biliary tract before, after and during operation. Nearly every surgeon uses x-ray study of the biliary tract before operation and it is widespread practice to carry out such study after operations in which a tube has been placed in the bile passages. However, there is a remarkable aversion to operative cholangiography.The usual reasons for avoiding operative cholangiography are unfamiliarity, inertia, concern over complications of the technique, and the feeling that it is unnecessary or wasteful of surgeon's time and patient's money. Yet the results of operative cholangiograms compare favorably with those obtained with the more customary x-ray studies of the bile ducts carried out after operation, at a time when the information gained is much less valuable in avoiding additional operations and in contributing to a smooth and rapid convalescence.