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W. L. ESTES Jr., M.D.
Arch Surg. 1938;36(5):849-857. doi:10.1001/archsurg.1938.01190230128009.
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The treatment for acute suppurative or gangrenous cholecystitis has recently been given renewed consideration. The controversial question has again been raised of immediate or early operation as against delay in operation, because the mortality following early operation has seemed to be lower than that following routine operative delay (Heuer). The operation of choice for acute or chronic cholecystic disease is removal of the gallbladder. One may expect a high mortality if cholecystectomy is invariably used on patients who are extremely ill or who are bad risks, and for such patients cholecystostomy, which is merely a palliative procedure in from 25 to 30 per cent of cases, must be resorted to. The likelihood that cholecystectomy must be performed subsequent to cholecystostomy because of recurrent symptoms or a persistent biliary fistula makes primary cholecystectomy particularly desirable. In cases of suppuration, cholecystectomy from above downward often proves to be easier. But when there


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