Wide variation in the use of laparoscopic surgery for gall bladder removal

There is a wide variation in the use of laparoscopic surgery for gall bladder removal in Hong Kong hospitals, and use of this procedure is more likely at certain hospitals and among younger female patients operated on more recently, according to a study in the Archives of Surgery.

Laparoscopic cholecystectomy (LC, removal of the gallbladder by laparoscopy) is a well-established technique for the management of symptomatic gallstone disease. But acute cholecystitis (inflammation of the gallbladder) has been considered a relative, if not absolute, contraindication for LC because of the technical difficulties and a higher complication rate, according to background information in the article.

Chi Ming Lam, M.S., F.R.C.S., and colleagues with the Hospital Authority, Hong Kong, China, and the University of Hong Kong, investigated the variation in surgical treatment of acute cholecystitis in a stable population and the factors determining the use of LC in the emergency condition. They conducted a retrospective survey on 2,353 patients with pathologically proven acute cholecystitis who had gallbladder surgery at all public hospitals in Hong Kong from 1998 to 2002. The study reflected the practice of LC for acute cholecystitis in about 86 percent of the inpatient population in Hong Kong.

"The rate of using LC for acute cholecystitis increased by 30.4 percent from 1998 to 2002," the authors report. "We observed a wide variation in the use of LC for acute cholecystitis ranging from 3.7 percent to 92.9 percent." Certain factors, including the hospital, year of operation, and patient age were associated with increased rates of LC. "Young female patients from selected hospitals [operated on] recently are more likely to be treated with LC," they continue.

The authors point out that even though the laparoscopic approach has become the method of choice for elective gallbladder removal, conventional open cholecystectomy still remains the treatment of choice for acute cholecystitis for many surgeons--mainly because of concerns about bile duct injuries and an excessively high conversion rate (a procedure that begins using the laparoscopic technique, but then requires "converting" to an open laparotomy for gall bladder removal).

"The application of LC in the emergency condition is technically demanding and certainly needs to be performed by experienced laparoscopic surgeons," they assert.

"The present study demonstrated that, on a population basis, the use of LC for acute cholecystitis is increasingly popular among surgeons," the authors conclude. "More LCs for acute cholecystitis have been performed recently. In a relatively stable population, younger female patients in selected hospitals are more likely to have LC for acute cholecystitis."

http://archsurg.ama-assn.org/