title: Building operative care capacity in a resource limited setting: The Mongolian model of the expansion of sustainable laparoscopic cholecystectomy.
abstract: The benefits of laparoscopic cholecystectomy, including rapid recovery and fewer infections, have been largely unavailable to the majority of people in developing countries. Compared to other countries, Mongolia has an extremely high incidence of gallbladder disease. In 2005, only 2% of cholecystectomies were performed laparoscopically. This is a retrospective review of the transition from open to laparoscopic cholecystectomy throughout Mongolia.
  
  
  
  A cross-sectional, retrospective review was conducted of demographic patient data, diagnosis type, and operation performed (laparoscopic versus open cholecystectomy) from 2005-2013. Trends were analyzed from 6 of the 21 provinces (aimags) throughout Mongolia, and data were culled from 7 regional diagnostic referral and treatment centers and 2 tertiary academic medical centers. The data were analyzed by individual training center and by year before being compared between rural and urban centers.
  
  
  
  We analyzed and compared 14,522 cholecystectomies (n = 4,086 [28%] men, n = 10,436 [72%] women). Men and women were similar in age (men 52.2, standard deviation 14.8; women 49.4, standard deviation 15.7) and in the percentage undergoing laparoscopic cholecystectomy (men 39%, women 42%). By 2013, 58% of gallbladders were removed laparoscopically countrywide compared with only 2% in 2005. In 2011, laparoscopic cholecystectomy surpassed open cholecystectomy as the primary method for gallbladder removal countrywide. More than 315 Mongolian health care practitioners received laparoscopic training in 19 of the country's 21 aimags (states).
  
  
  
  By 2013, 58% of cholecystectomies countrywide were performed laparoscopically, a dramatic increase over 9 years. The expansion of laparoscopic cholecystectomy has transformed the care of biliary tract disease in Mongolia despite the country's limited resources.
authors.affiliation: The University of Utah Center for Global Surgery, Salt Lake City, UT; The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Katie M
authors.initials: KM
authors.lastname: Wells
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Yu-Jin
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Mongolia Health Sciences University and First Central Hospital Mongolia, Ulaanbaatar, Mongolia.
authors.forename: Sandag
authors.initials: S
authors.lastname: Erdene
authors.affiliation: Mongolia Health Sciences University and First Central Hospital Mongolia, Ulaanbaatar, Mongolia.
authors.forename: Sarnai
authors.initials: S
authors.lastname: Erdene
authors.affiliation: Second General Hospital Mongolia, Ulaanbaatar, Mongolia.
authors.forename: Urjin
authors.initials: U
authors.lastname: Sanchin
authors.affiliation: Mongolia Health Sciences University and First Central Hospital Mongolia, Ulaanbaatar, Mongolia.
authors.forename: Orgoi
authors.initials: O
authors.lastname: Sergelen
authors.affiliation: Department of Internal Medicine and Epidemiology, Salt Lake City, UT.
authors.forename: Chong
authors.initials: C
authors.lastname: Zhang
authors.affiliation: The University of Utah Center for Global Surgery, Salt Lake City, UT.
authors.forename: Brandon P
authors.initials: BP
authors.lastname: Rodriguez
authors.affiliation: The University of Utah Center for Global Surgery, Salt Lake City, UT.
authors.forename: Catherine R
authors.initials: CR
authors.lastname: deVries
authors.affiliation: The University of Utah Center for Global Surgery and Intermountain Healthcare, Salt Lake City, UT. Electronic address: rayrprice@comcast.net.
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Price
mesh_terms: D000328:Adult; D000368:Aged; D057191:Capacity Building; D017081:Cholecystectomy, Laparoscopic / Q000193:education / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D005705:Gallbladder Diseases / Q000453:epidemiology / Q000601:surgery*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D008986:Mongolia / Q000453:epidemiology; D012189:Retrospective Studies