5 YEARS OF LAPAROSCOPIC CHOLECYSTECTOMY IN THE NETHERLANDS

Since its introduction in spring 1990, laparoscopic cholecystectomy ha s become the treatment of choice for uncomplicated gallstone disease i n The Netherlands, Several nation-wide surveys conducted by the author s show a rapid diffusion of this operation, 70-75% of all cholecystect omies are performed laparoscopically in almost all Dutch hospitals, Th e incidence of common bile duct lesions was relatively high at the beg inning (1% in 1991) but declined to 0.68% at the end of 1992, It is as sumed that the incidence of these lesions will decrease further to a p ercentage comparable to that after conventional cholecystectomies of 0 .5%. The wound related complications of 1.65% is rather low Despite th e reduction in operative morbidity and early resumption of full activi ty resumption laparoscopic cholecystectomy has met financial restraint s, because of the budget system in The Netherlands, There are no incen tives for surgeons, hospital management and health insurance companies to stimulate laparoscopic cholecystectomy. The social-economic benefi t of the operation is difficult to quantify in the current health care system in The Netherlands.