Incidence and indications for cholecystectomy in a public health district of a small town in central Italy.

There are major differences in cholecystectomy rates between different countries. We prospectively recorded all gallbladder operations in L'Aquila, Italy (a small town in central Italy with a population of about 98,700 inhabitants) from June 15, 1987 to June 14, 1988. During that year 210 cholecystectomies were performed (women and girls = 71.4%), for a calculated yearly incidence rate of 0.212%. Cholecystectomy was elective in 85.2%, urgent in 8.6%, and was performed in the course of other abdominal operations (mainly colon cancer) in the remaining 6.2%. Half (44.3%) of the patients were operated on because of at least one episode of biliary colic, and 9.0% because of an acute complication. Respectively 16.2% and 30.5% were operated on because of dyspeptic symptoms or to prevent symptoms or complications. Gallstones were not found in six, while exploration of the common bile duct revealed gallstones in seven patients. The chemical analysis showed that 84.7% were cholesterol stones (mixed or pure). We presume that most observed differences in cholecystectomy rates between different Western countries are more likely owing to differences in indications for surgery rather than to differences in prevalence of gallstones.