A SURVEY OF SURGICAL-TREATMENT OF GALLSTONE DISEASE AND THE DIFFUSIONOF LAPAROSCOPIC SURGERY IN SWEDEN 1992-93

Objective: To study the diffusion of laparoscopic biliary surgery in S weden, 1992-93. Design: A prospective survey of all biliary surgery fo r gallstone disease recorded for 8 weeks in 1992 and the same period i n 1993. Setting: All surgical departments in Sweden. Subjects: A conse cutive series of 1938 patients in 1992 and 1748 patients in 1993. Main outcome measures: The changing indications, diffusion, morbidity, mor tality, postoperative and hospital stay after laparoscopic cholecystec tomy (LC) in Sweden in 1992 compared with 1993. Results: Despite the s pread of LC, the indications did not change between 1992 and 1993 (p = 0.31). The total number of cholecystectomies decreased from 1938 in 1 992 to 1748 in 1993. The overall percentage of laparoscopic cholecyste ctomies (LCs) increased from 74.7% to 81.2% (p < 0.001) between 1992 a nd 1993. Postoperative morbidity and mortality after LC did not differ between 1992 and 1993, but the total morbidity was 9.0% in 1992 and 7 .0% in 1993 (p = 0.02). Mortality for all cholecystectomies did not ch ange over the periods, being 0.6% in 1992 and 0.2% in 1993 (p = 0.07). The numbers of LCs done in any hospital were divided in two groups, 2 0 or fewer and 21-80. In the smaller group, the postoperative morbidit y was 7.1% and in the larger group it was 7.0%, (p = 0.9).The postoper ative mortality was 0.1% in both groups. The postoperative and total h ospital stays of all cholecystectomies decreased from 3.4 days in 1992 to 2.9 days in 1993 (p = 0.001) and from 5.0 in 1992 to 4.4 days in 1 993 (p < 0.001), respectively. The postoperative and total hospital st ays of LCs decreased from 2.0 in 1992 to 1.8 days in 1993 (p = 0.009) and from 3.3 in 1992 to 2.9 days in 1993 (p = 0.007), respectively. Co nclusion: Despite the introduction and diffusion of the new technology , LC, the indications for surgery did not change and the number of cho lecystectomies did not increase from 1992 to 1993. The morbidity and m ortality of LC and the mortality of all cholecystectomies were unchang ed between 1992 and 1993, but the morbidity for all cholecystectomies decreased. The number of LC or all cholecystectomies done in any parti cular hospital were not related to morbidity or to mortality.