THE incidence of biliary tract disease appears significantly greater among American Indians than among Caucasians1,2 and has been called the Southwestern American Indians' burden.3 However, there has been no report in the literature adequately reviewing the surgical treatment of these patients. In order to better view biliary surgery in the Southwestern American Indian as compared to surgical treatment among Caucasians, the present study was undertaken. Material The US Public Health Service Indian Hospital, Gallup, NM, has been in operation for six years. Three years were selected at random for study and all gallbladder surgery was reviewed from this period. Two hundred and forty-nine biliary tract procedures were performed on 237 patients. This represented 26.3% of the 946 major operations done on the general surgical service. One hundred and eighty-eight of these patients were Navajo, while the remainder were Zuni, Hopi, Apache, and Laguna. There were 59 men—average age