[Natural history of cholelithiasis and incidence of cholecystectomy in an urban and a Mapuche rural area].
BACKGROUND
Cholelithiasis is the second cause of hospital admissions in Chile.


OBJECTIVE
To study the prevalence of symptomatic gallstone disease and opportunity of cholecystectomy in La Florida, Santiago and among Mapuche Indians in Huapi Island.


METHODS
In the period 2000-2001, we contacted to 71% (1127 subjects) and to 61% (145 subjects) patients of La Florida and Huapi Island, respectively, that had previously participated in an epidemiological study on cholelithiasis in 1993. We defined symptomatic gallstone patients as those with a history of biliary colic. Each patient was subjected to gallbladder ultrasound.


RESULTS
In 1993, 30-35% of gallstone patients were symptomatic (approximately 70% women). During the lapse 1993-2001, only 50% of subjects from La Florida and 25% of patients from Huapi Island were cholecystectomized (p < 0.05). Fifty percent of cholecystectomies were emergency operations. In 38 symptomatic Mapuche Indians from Huapi, cholecystectomy was indicated in 2001. After five months of the indication, only one of these subjects had been operated. Laparoscopic cholecystectomy represented 40% of all cholecystectomies performed in the National Health Service Hospitals.


CONCLUSIONS
This study demonstrates an unacceptable high prevalence of symptomatic gallstone patients remaining non-operated in both the urban and rural communities. This reciprocally correlates with the high frequency of emergency cholecystectomies and the high incidence of gallbladder cancer among Chileans. This study contrasts negatively with the situation of Scotland, where 73.5% of cholecystectomies were laparoscopic in 1998-1999. To reach Scotland standards, the Chilean Public Health System should increase the number of cholecystectomies from 27,000 in 2001 to 57,510
Pérez-Ayuso
Rosa María
RM
Departamentos de Gastroenterología y Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago.
Hernández
Verónica
V
González
Berta
B
Carvacho
Claudia
C
Navarrete
Carlos
C
Alvarez
Manuel
M
González
Robinson
R
Marshall
Guillermo
G
Miquel
Juan Francisco
JF
Nervi
Flavio
F
D000328:Adult; D002677:Chile / Q000453:epidemiology / Q000208:ethnology; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data; D002769:Cholelithiasis / Q000453:epidemiology / Q000208:ethnology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007199:Indians, South American; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D014505:Urban Population