THE CHANGING FACE OF CHOLECYSTECTOMY

Previous reports in selected patient populations have noted an increas e in the number of cholecystectomies since the introduction of laparos copic cholecystectomy. To assess the impact of laparoscopic cholecyste ctomy in a more general population, 6473 consecutive cholecystectomies from 7/1/86 to 6/30/95 were reviewed to assess changes in rate of cho lecystectomy, diagnosis leading to cholecystectomy, and general patien t demographics. During the 9-year period, the number of cholecystectom ies increased from 618 to 800 per year (29%; P < 0.002). Even more str iking was the redistribution of cholecystectomies performed for acalcu lous disease (P < 0.0001), with the rate of increase more than doublin g for each individual diagnosis (biliary dyskinesia, 348%; acute acalc ulous cholecystitis, 139%; chronic acalculous cholecystitis, 138%). Wh en 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 cholecys tectomy for chronic acalculous cholecystitis at a higher rate (120%; P < 0.0003). The introduction of laparoscopic cholecystectomy was follo wed by a dramatic increase in cholecystectomies performed for acalculo us disease and less so for cholelithiasis. Accompanying the increase w ere significant alterations in patient demographics. The study provide s indirect evidence for lowering thresholds and changing indications w ith reasons for the increases yet to be determined.