Who Performed the First Cholecystectomy?
Carl Langenbuch performed the first cholecystectomy at the Lazarus Hospital in Berlin in July 1882 on a 43-year-old patient. 1, 2
Historical Context and Significance
Langenbuch's groundbreaking operation was not a spontaneous decision but rather the culmination of careful scientific preparation:
- He conducted scientific experiments, cadaver dissections, and meticulous patient selection before attempting the procedure 1
- At age 27, he had been appointed Director of the Lazarus Hospital in Berlin, where he performed this historic operation 1
- His revolutionary insight was that the gallbladder should be removed not because it contained stones, but because it originated the stones 2
The Controversial Reception
The introduction of cholecystectomy sparked intense international debate that persisted for decades:
- Prior to Langenbuch's innovation, treatment for cholecystitis consisted of stone extraction from spontaneous cutaneous biliary fistulas or cholecystostomy (drainage procedures) 1
- Cholecystostomy had been championed by prominent surgeons including Bobbs (1867), Sims (1878), Kocher (1878), and Tait (1879) 1
- Lawson Tait, a famous abdominal surgeon, became a strong opponent of cholecystectomy, maintaining cholecystostomy as the procedure of choice and rejecting cholecystectomy in unequivocal terms in medical journals 2
- The controversy centered on whether the gallbladder was dispensable, given its alleged role in bile physiology 2
- This debate delayed the wide acceptance of cholecystectomy for several decades 2
Langenbuch's Broader Contributions
Beyond the first cholecystectomy, Langenbuch made additional pioneering contributions to hepatobiliary surgery:
- He subsequently recommended choledochotomy, duodenotomy, and sphincterotomy for managing stones in the bile ducts 1
- He performed one of the earlier major right liver resections in 1888 1
- He was also known for sciatic nerve stretching for tabes dorsalis and management of gunshot wounds 1
Evolution to Modern Practice
Since Langenbuch's 1882 innovation, cholecystectomy has become the standard treatment for gallstone disease, with mortality now less than 1% 3. The procedure evolved further with the introduction of laparoscopic cholecystectomy in 1987, which has since become the procedure of choice for symptomatic gallbladder disease 3, 4.