The surgical gallbladder.

A series of 412 personally performed cholecystectomies is analyzed and discussed. Surgical cases were divided into groups based on whether or not the gallbladder was visualized by cholecystography. A third group required immediate surgery without attempting radiologic investigation. We do not accept the diagnosis of dyskinesia which is a radiological finding as an indication for surgery and no such cases are included in the series. Quite a number of cases operated on for "chronic cholecystitis" were found at surgery to have other less common pathological lesions, as proved by later histologic examination of the excised gallbladders. Bilharzial gallbladder disease is discussed and the new terms bilharzial cholecystitis and bilharzioma of the gallbladder are suggested for the lesions described. We stress the need to explore, inspect and aspirate the common bile duct in every case of calculous cholecystitis as the only alternative to operative cholangiography. By so doing biliary fistulas were completely eliminated from the series.