THIS COMMUNICATION records a critical analysis of patients returning to the Follow-Up Clinic of the Hospital of the University of Pennsylvania, from one to four years after cholecystectomy, with symptoms indicating that the operation had not given them the relief which either they or their surgeon anticipated. The cases were selected from a larger series, of 504 patients with gallbladder disease, operated upon on the service of Dr. E. L. Eliason, during the I2 years from I922 to I934. Various aspects of this complete series, including mortality, type of pathology encountered, and operative technic, have recently been reported by Eliason and Erb.2 The present discussion is not concerned with such factors as these, nor with anatomic defects, such as postoperative hernia, wound infection or fistula, but only with unsatisfactory functional end-results. Moreover, since the inadequacy of cholecystostomy as compared with cholecystectomy is well recognized, we will confine ourselves to the results after the latter procedure.There are available for review, 264 instances of cholecystectomy, whose records include follow-up notes extending over a period of at least one year, a follow-up percentage of 85 of all cholecystectomies performed during this period. Two hundred thirty-six of these patients, or 89 per cent, have reported themselves in good health and relieved of all symptoms. In the records of the remaining 28, mention is made of one or more residual symptoms. In seven instances, these symptoms were found on investigation to be due to causes extraneous to the biliary tract and for the most part developing after the operation. These patients were entirely free of symptoms related to the gallbladder or ducts and will be discussed as Group IV. In five patients, notes made soon after operation indicate persistence of biliary symptoms, but later the patients in this group (Group III) obtained complete relief. There are left i6 patients with residual trouble of one form or another, definitely attributable to the biliary system, or attributed to this system correctly or incorrectly at the time operation was determined upon. To put the matter in another way, this analysis shows that cholecystectomy gave ultimate relief to 94 per cent.The I6 unrelieved patients may be subdivided into two groups. Group I are those in whom no significant biliary lesion was found at operation. The preoperative diagnosis was, therefore, incorrect. Group II consists of those who, at operation, had definite lesions of the gallbladder or its ducts but whose symptoms persisted despite the removal of the gallbladder. In most instances, these patients gave atypical histories of gallbladder disease or re-
