The impact of laparoscopic cholecystectomy on the treatment of symptomatic cholelithiasis.
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.
Ho
H S
HS
Department of Surgery, Davis Medical Center, University of California, 4301 X Street, Sacramento, CA 95817-2214, USA.
Mathiesen
K A
KA
Wolfe
B M
BM
D000328:Adult; D000368:Aged; D002140:California; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate