Five years of laparoscopic cholecystectomy in The Netherlands

Since its introduction in spring 1990, laparoscopic cholecystectomy has become the treatment of choice for uncomplicated gallstone disease in The Netherlands. Several nation-wide surveys conducted by the authors show a rapid diffusion of this operation. 70-75% of all cholecystectomies are performed laparoscopically in almost all Dutch hospitals. The incidence of common bile duct lesions was relatively high at the beginning (1% in 1991) but declined to 0.68% at the end of 1992. It is assumed that the incidence of these lesions will decrease further to a percentage comparable to that after conventional cholecystectomies of 0.5%. The wound related complications of 1.65% is rather low. Despite the reduction in operative morbidity and early resumption of full activity resumption laparoscopic cholecystectomy has met financial restraints, because of the budget system in The Netherlands. There are no incentives for surgeons, hospital management and health insurance companies to stimulate laparoscopic cholecystectomy. The social-economic benefit of the operation is difficult to quantify in the current health care system in The Netherlands.