THE IMPACT OF LAPAROSCOPIC CHOLECYSTECTOMY ON THE TREATMENT OF SYMPTOMATIC CHOLELITHIASIS

Background: There has been a debate about the cost-effectiveness of la paroscopic cholecystectomy (LC), as well as a concern regarding its po ssible overutilization and changes in the indication for surgery. Meth ods: A retrospective analysis of all cholecystectomies performed at UC DMC from 1988 to 1994 was done. The annual rate of cholecystectomy inc reased by 50% in 1990 when LC was introduced but has since stabilized at a rate 11% higher than the rate before LC. The disease status and s everity did not change. Results: The incidence of nonelective surgery remained stable at 31.2% to 37.5%. Elective cholecystectomy had lower mortality (0.16% vs 1.8%, P = 0.029), morbidity (2.6% vs 11.2%, P = 0. 0001), and conversion rate (2.6% vs 16%, P = 0.0001) and a shorter len gth of stay (2.1 days vs 5.4 days), compared with nonelective procedur e. Conclusions: The indication for surgery in cholelithiasis has not c hanged since the introduction of LC, In patients with symptomatic gall stones, early elective surgery is recommended and may be more cost-eff ective.