The changing face of cholecystectomy

Previous reports in selected patient populations have noted an increase in the number of cholecystectomies since the introduction of laparoscopic cholecystectomy. To assess the impact of laparoscopic cholecystectomy in a more general population, 6473 consecutive cholecystectomies from 7/1/86 to 6/30/95 were reviewed to assess changes in rate of cholecystectomy, diagnosis leading to cholecystectomy, and general patient demographics. During the 9- year period, the number of cholecystectomies increased from 618 to 800 per year (29%; P < 0.002). Even more striking was the redistribution of cholecystectomies performed for acalculous disease (P < 0.0001), with the rate of increase more than doubling for each individual diagnosis (biliary dyskinesia, 348%; acute acalculous cholecystitis, 139%; chronic acalculous cholecystitis, 138%). When comparing patient characteristics, there was a significant increase in the number of cholecystectomies performed on females when compared with males. When compared with other races, whites underwent cholecystectomy for chronic acalculous cholecystitis at a higher rate (120%; P < 0.0003). The introduction of laparoscopic cholecystectomy was followed by a dramatic increase in cholecystectomies performed for acalculous disease and less so for cholelithiasis. Accompanying the increase were significant alterations in patient demographics. The study provides indirect evidence for lowering thresholds and changing indications with reasons for the increases yet to be determined.