[Early bile drainage in acute cholangitis]

OBJECTIVE

We have studied the impact of early biliary drainage (surgical or endoscopical) on morbidity-mortality of acute cholangitis.

PATIENTS AND METHODS

During a five-year period (1988-1992) 106 patients were diagnosed of acute cholangitis (clinically, echographically and microbiologically).

RESULTS

Surgical intervention was performed in 78% of the patients, endoscopic biliary drainage in 18% and in 4% medical treatment alone. In 65% of cases, biliary drainage was performed during the eight hours after diagnosis. Overall mortality rate was 3, 7% (4 patients).

CONCLUSIONS

Our results suggest that early biliary drainage of acute cholangitis is the most important factor in order to achieve a low mortality rate.

Prepyloric antrectomy, truncal vagotomy, and front pylorotomy for the treatment of duodenal ulcer

We have performed a suprapyloric antrectomy with anterior pylorotomy and truncal vagotomy in 106 patients with chronic duodenal ulcer between 1975 and 1990. Follow-up was carried out in 94 patients, during a mean time of 6 years. We have had no postoperative mortality and no long-term recurrence. The percentage of Visick I patients is similar to that after truncal vagotomy and antrectomy. We, therefore, believe that this procedure is safe and can be performed when an antrectomy is mandatory to avoid the operative morbidity and mortality of classic antrectomy.

The influence of age on early surgical treatment of acute cholecystitis

This study was undertaken to assess the influence of age on the early surgical treatment of acute cholecystitis. One hundred consecutive patients who had early operations for acute cholecystitis were divided into two groups according to age. Group 1 consisted of 41 patients who were younger than 60 years of age, and group 2 was made up of 59 patients who were more than 60 years of age. Shock, leukocytosis, hyperglycemia and uremia were more common in those patients in group 2 (p less than 0.05). The over-all diagnostic effectiveness was 94 per cent. The mortality rate was 4.1 per cent (n = 4). There were no significant differences in morbidity and mortality between both groups. In conclusion, advanced age is not a contraindication for early surgical treatment of acute cholecystitis.