Development of gallstone surgery in Germany

The aim of this study was to evaluate the development and outcome of laparoscopic gallstone surgery in Germany in a nationwide representative survey.

A written questionnaire, which included 111 structured items about diagnostic and therapeutic approaches, number of procedures, complications, and mortality, was sent to 449 randomly selected German surgeons (20% of the registered German general surgeons) annually from 1991 to 1994.

A total number of 72,455 operations for gallstone disease was reported. The frequency of laparoscopic cholecystectomies increased from 24. 9% in 1991 to 65.3% in 1993. In 1994, 92% of the polled surgeons were using the laparoscopic approach as compared with 10% in 1991. The results demonstrated significantly lower morbidity (6% vs. 9%) and mortality figures (0.14-0.45%) than for the open procedure. The percentage of common bile duct (CBD) injuries was significantly higher for the laparoscopic group than for the open treatment group (0.7% vs. 0.4%). In 1993 the data shows a significant decrease in surgical complications such as bleeding, CBD injuries, and relaparotomy rate for the laparoscopic procedures. No changes were seen in the mortality rate.

These results show learning curves that project a positive trend in the overall risk incurred by laparoscopic cholecystectomy in Germany during the past few years. This can be seen as an effect of better training and experience. Obviously, CBD injuries and technical problems especially have passed their peak of incidence.