title: Improved acceptability of laparoscopic surgery and increasing rate of cholecystectomy implications for surgeon and patients.
abstract: OBJECTIVE
  The aim of our study was to evaluate the impact of introduction of laparoscopic cholecystectomy (LC) and reasons for the increase in cholecystectomy rate, by a retrospective review of all admissions for gallbladder disease before and after the introduction of laparoscopic surgery in our department.
  
  
  METHODS
  Chi-squared test was used for statistical analysis of the comparisons.
  
  
  RESULTS
  Comparing the 2 periods, cholecystectomy rate increased by 35% (p<0.01) and patients aged 25-44 years were more likely to undergo LC (p<0.001); a 35% decrease in unjustified refusal (p<0.02) was also observed. The number of both longstanding disease patients and asymptomatic ones operated upon was not different (p=1; p=0.06), while a 46% increase (p=0.02) in cholecystectomy rate was shown in patients with low-grade symptoms or at 1st colic episode.
  
  
  CONCLUSIONS
  An increase in the patient pool due to improved acceptability was responsible for the increase in cholecystectomy rate after introduction of laparoscopic surgery, rather than lowered surgical threshold, as previously suggested by other authors. Judiciousness is required to prevent the increased acceptability of LC from leading to its uncontrolled and unrestricted use, as alteration of the surgical threshold may occur without surgeon awareness, particularly when dealing with low grade symptomatic patients.
authors.affiliation: 1st Department of Surgical Pathophysiology, University of Bari, Policlinico Hospital, Italy.
authors.forename: F M
authors.initials: FM
authors.lastname: Polignano
authors.forename: A
authors.initials: A
authors.lastname: Pezzolla
authors.forename: S
authors.initials: S
authors.lastname: Camporeale
authors.forename: F
authors.initials: F
authors.lastname: Ferrarese
authors.forename: S
authors.initials: S
authors.lastname: Ferrarese
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data