Why Are Cholecystectomy Rates Increasing?

Although the laparoscopic approach to cholecystectomy was introduced only about 5 years ago, it now accounts for some 90% of all cholecystectomies done in the United States. Following the introduction of this type of "minimally invasive surgery," the overall number of procedures has increased by about 22%, at least in the elderly in Pennsylvania described in this issue ofJAMAby Escarce et al.1What is the explanation for this change in practice behavior, and is the change for the better? See also p 1581. The laparoscopic approach clearly is more convenient than the open approach to cholecystectomy because it requires shorter hospital stay and allows quicker return to work. Indeed, the rapid and widespread adoption of laparoscopic cholecystectomy appears to have been in large part patient driven because of the procedure's convenience. The laparoscopic approach is believed to be as safe as or perhaps safer than open cholecystectomy,