Rate of surgery for gall stones is increasing

BMJ 1995;311:1092 (21 October)

Letters

Rate of surgery for gall stones is increasing

EDITOR,--In their review on the treatment of gall stones N Taitand J M Little suggest that the selection of patients for cholecystectomyhas not been changed by the introduction of laparoscopic surgery.¹Our work² and studies by others,³ ⁴ ⁵ however, have shown thatthe total cholecystectomy rate has increased by an average of25% since the introduction of laparoscopic cholecystectomy.

The causes for this increased rate have not been studied prospectively.The underlying reasons are probably multifactorial. Some patientswith mild symptoms, who may be reluctant to have open surgery,may consent to laparoscopic surgery because it inflicts lesspostoperative pain and entails a shorter period of disability.This is the "enlarged patient pool factor." Secondly, a changein the surgeons' perception of the ratio of risk to benefitmay result in a change in the indications for cholecystectomy.This is the "lower surgical threshold factor." Thirdly, gastroenterologistsmay increase . . . [Full text of this article]