More people are having unnecessary gall bladder operations simply because surgeons find the new surgical techniques easier to perform.
Operations increased by 22 per cent in America between 1993 and 1989 when laparoscopic or keyhole surgery was introduced for cholecystectomies, or gall bladder removals.
A study team looking into this sudden increase discovered that surgeons had lowered the clinical threshold for considering surgery because the technique was easier to perform. As a result, previously marginal cases, and some unsuitable ones, were now having the operation.
This increase is hard to justify in the case of gallstones which, in the main, are benign and painless. Those in pain or danger would have had an operation anyway, even before the days of laparoscopy, commented David Ransohoff and Charles McSheery, writing in an editorial of Journal of the American Medical Association, which published the study paper.
In addition, they write, patients undergoing unnecesary surgery run the small risk of a bile duct injury, which can sometimes happen during keyhole surgery. Although the rate is only 0.2 per cent, this translates into a significant number among people who have the operation. For instance, just among the 53,936 patients monitored in the study between 1989 and 1993, some 107 many of them young would have suffered some permanent injury with bile duct problems for the rest of their lives (JAMA, May 24, 1995).