Impact of laparoscopy on frequency of surgery for treatment of gallstones.

Although the indications for laparoscopic cholecystectomy are generally the same as those for open cholecystectomy, there has been a suspicion that indications for cholecystectomy have broadened and the spectrum of patients undergoing this procedure has changed. This study was designed to determine whether surgeons and patients have lowered the threshold for proceeding to cholecystectomy with use of laparoscopic cholecystectomy. Discharge data were collected for all patients who underwent an elective operation in general surgery clinics in Ankara Numune Teaching and Research Hospital between 1990 to 2001. The rate of total cholecystectomy to all elective operations and rate of laparoscopic technique to all cholecystectomies were analyzed. Total number of operations and rate of cholecystectomy were relatively stable over 6 years prior to laparoscopy. With the introduction of laparoscopic cholecystectomy, although total number of elective operations seems stable, the proportion of cholecystectomy to all operations showed an increase. Our study could not explain the increase of total number of cholecystectomies since the widespread introduction of laparoscopy. First, it may be due to changing selection criteria for surgical treatment of gallstones. Second, surgery may have been done for asymptomatic gallstones. And third, patients with moderate symptoms who refused the (open) operation in the past may now be more willing to undergo a laparoscopic cholecystectomy.