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December 1989

Ongoing 'Threats' to Biliary Surgery

Author Affiliations

New York, NY

Arch Surg. 1989;124(12):1368. doi:10.1001/archsurg.1989.01410120014003

Cholecystectomy is the most commonly performed operation in the United States. More than 500 000 procedures are done annually. For the past 20 years there has been an increasing emphasis on nonoperative therapy of biliary disease.

Attempts at chemical dissolution of gallstones by solubilizing bile salts and cholesterol (chenodeoxycholic and ursodeoxycholic acid) have been unsuccessful in more than 80% of patients. M terbutyl ether injected into the gallbladder provides dramatic dissolution of stones. There are several limiting factors, including biliary access, duodenal injury, the safety of the volatile ether, and the fact that ether is not approved for widespread use.

Lithotripsy is the latest challenge to the biliary surgeon. While eagerly awaited by a public anxious to avoid surgery, lithotripsy is not without its disappointments and complications; also, it is expensive ($7000), and more than one treatment may be necessary (approximately 30%).

Added to these "threats" are endoscopic and percutaneous

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