Skip to main content
SpringerLink
Log in

The impact of laparoscopic cholecystectomy on the treatment of symptomatic cholelithiasis

  • Original Articles
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background: There has been a debate about the cost-effectiveness of laparoscopic cholecystectomy (LC), as well as a concern regarding its possible overutilization and changes in the indication for surgery.

Methods: A retrospective analysis of all cholecystectomies performed at UCDMC from 1988 to 1994 was done. The annual rate of cholecystectomy increased 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 severity 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 length of stay (2.1 days vs 5.4 days), compared with nonelective procedure.

Conclusions: The indication for surgery in cholelithiasis has not changed since the introduction of LC. In patients with symptomatic gallstones, early elective surgery is recommended and may be more cost-effective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Asch DA, Hershey JC (1995) Why some health policies don't make sense at the bedside. Ann Intern Med 122: 846–850

    Google Scholar 

  2. Diehl AK (1993) Laparoscopic cholecystectomy. Too much of a good thing? JAMA 270: 1469–1470

    Google Scholar 

  3. Diettrich NA, Cacioppo JC, Davis RP (1988) The vanishing elective cholecystectomy. Trends and their consequences. Arch Surg 123: 810–814

    Google Scholar 

  4. Ganey JB, Johnson PA, Prillaman PE, McSwain GR (1986) Cholecystectomy: clinical experience with a large series. Am J Surg 151: 352–357

    Google Scholar 

  5. Glenn F (1975) Trends in surgical treatment of calculous disease of the biliary tract. Surg Gynecol Obstet 140: 877–884

    Google Scholar 

  6. Legorreta AP, Silber JH, Costanino GN, Kobylinski RW, Zatz SL (1993) Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy. JAMA 270: 1429–1432

    Google Scholar 

  7. Madden JL (1973) Common duct stones. Their origin and surgical management. Surg Clin North Am 53: 1095–1110

    Google Scholar 

  8. McSherry CK, Glenn F (1980) The incidence and causes of death following surgery for nonmalignant biliary tract disease. Ann Surg 191: 271–275

    Google Scholar 

  9. Munoz E, Tinker MA, Margolis I, Wise L (1984) Surgonomics: the cost of cholecystectomy. Surgery 96: 642–646

    Google Scholar 

  10. NIH Consensus Conference (1993) Gallstones and laparoscopic cholecystectomy. JAMA 269: 1018–1024

    Google Scholar 

  11. Orlando III R, Russell JC, Lynch J, Mattie A for the Connecticut Laparoscopic Cholecystectomy Registry (1993) Laparoscopic cholecystectomy. A statewide experience. Arch Surg 128: 494–499

    Google Scholar 

  12. Petelin JB (1993) Laparoscopic approach to common duct pathology. Am J Surg 165: 487–491

    Google Scholar 

  13. Ransohoff DF, Gracie WA (1990) Management of patients with symptomatic gallstones: a quantitative analysis. Am J Med 88: 154–160

    Google Scholar 

  14. Roslyn JJ, Binns GS, Hughes EFX, Saunders-Kirkwood K, Zinner MJ, Cates JA (1993) Open cholecystectomy. A contemporary analysis of 42,474 patients. Ann Surg 218: 129–137

    Google Scholar 

  15. Saunders-Kirkwood KD, Aizen B, Thompson JE, Zinner MJ, Cates JA, Bennion R, Gill J, Boudi F, Roslyn JJ (1992) Cholecystectomy. The impact of socioeconomic change. Ann Surg 215: 318–325

    Google Scholar 

  16. Schwesinger WH, Page CP, Sirinek KR, Levine BA, Aust JB (1991) Biliary pancreatitis. Operative outcome with a selective approach. Arch Surg 126: 836–840

    Google Scholar 

  17. Soper NJ, Brunt M, Callery MP, Edmundowicz SA, Aliperti G (1994) Role of laparoscopic cholecystectomy in the management of gallstone pancreatitis. Am J Surg 167: 42–51

    Google Scholar 

  18. Stryker SJ, Beal JM (1983) Acute cholecystitis and common duct calculi. Arch Surg 118: 1063–1063

    Google Scholar 

  19. Voyles CR, Sanders DL, Hogan R (1994) Common bile duct evaluation in the era of laparoscopic cholecystectomy. Ann Surg 219: 744–752

    Google Scholar 

  20. Wolfe BM, Gardiner BN, Leary BF, Frey CF (1991) Endoscopic cholecystectomy. An analysis of complications. Arch Surg 126: 1192–1198

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Davis Medical Center, University of California, 4301 X Street, 95817-2214, Sacramento, CA, USA

    H. S. Ho, K. A. Mathiesen & B. M. Wolfe

Authors
  1. H. S. Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. A. Mathiesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. M. Wolfe
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ho, H.S., Mathiesen, K.A. & Wolfe, B.M. The impact of laparoscopic cholecystectomy on the treatment of symptomatic cholelithiasis. Surg Endosc 10, 746–750 (1996). https://doi.org/10.1007/BF00193049

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00193049

Key words

Search

Navigation