Gallstones and cholecystectomy in modern Britain
M C Bateson
Department of
Gastroenterology, Bishop Auckland General Hospital, Cockton Hill Road,
Bishop Auckland, County Durham DL14 6AD, UK
Correspondence to: Dr Bateson
Submitted 22
November 1999;
Accepted 4 April 2000
BACKGROUND
It has been suggested
that gallstone disease is now commoner, and that this might explain an
increase in cholecystectomy rates, though conclusive evidence has been lacking.
METHODSAll the non-forensic
necropsy results for Dundee 1953-98 were examined to assess the
prevalence of gallstone disease. The NHS Scotland annual
cholecystectomy figures were extracted from their earliest availability
in 1961 up to the present. The subgroup of patients from Dundee was
analysed separately, as were laparoscopic procedures, which were
recorded from 1991.
RESULTSGallstone disease was
much commoner in 1974-98 than in 1953-73. Increasing age was the main
determinant of gallstone disease. Though gallstone disease was commoner
in women than men aged 40-89, there was no sex difference under 40 or
over 90 years. Cholecystectomy became much commoner in the 1960s when
frequency of gallstone disease did not change. It increased further in
the 1970s, peaking in 1977-8. There was a gradual fall in rates in the
1980s when gallstone prevalence remained high. There was a further
moderate rise in the 1990s after the wide introduction of laparoscopic cholecystectomy. Cholecystectomy is now much commoner in young women
and this change started in the 1960s. By contrast, cholecystectomy in
men has become more prevalent in the older age group.
CONCLUSIONSGallstones were
definitely more common in both sexes at all ages over 40 in the last 25 years. Changes in the cholecystectomy rates are only partly explained
by changes in gallstone prevalence, and are more determined by surgical practice.
Keywords: cholecystectomy; gallstones
© 2000 by The Fellowship of Postgraduate Medicine
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