Cholecystectomy following the introduction of laparoscopy: more, but for the same indication.

To assess whether indications for cholecystectomy might have changed after the introduction of laparoscopic cholecystectomy (LC), the data from patients undergoing cholecystectomy at the University of South Alabama Medical Center during 1988 (before LC) and 1993 (after the introduction of LC) were retrospectively analyzed and compared. In 1993, the number of patients undergoing cholecystectomy for gallstone-related disease was 18 per cent higher than in 1988 (87 vs 103, 1.4 per cent of all noncardiac operations vs 2.7 per cent, Chi square; P = 0.003). There was no difference in the mean Preoperative Severity Index, a quantitative evaluation of symptom complex, preoperative laboratory evaluation, and radiological findings. Besides obesity, there were also no differences between the groups in associated comorbidities that might affect the decision to proceed with operation. Furthermore, pathologic findings, including the distribution of patients with gallstone pancreatitis, symptomatic cholelithiasis, chronic cholecystitis, and acute cholecystitis, were similar in both groups. The indications for cholecystectomy did not broaden after the introduction of LC, but rather, more patients with similar indications are undergoing cholecystectomy now, as compared with the pre-laparoscopic era.