Increased rate of cholecystectomies performed with doubtful or no indications after laparoscopy introduction: a single center experience

Background During recent years laparoscopic cholecystectomy has dramatically increased, sometimes resulting in overtreatment. Aim of this work was to retrospectively analyze all laparoscopic cholecystectomies performed in a single center in order to find the percentage of patients whose surgical treatment may be explained with this general trend, and to speculate about the possible causes. Methods 831 patients who underwent a laparoscopic cholecystectomy from 1999 to 2008 were retrospectively analyzed. Results At discharge, 43.08% of patients were operated on because of at least one previous episode of biliary colic before the one at admission; 14.08% of patients presented with acute lithiasic cholecystitis; 14.68% were operated on because of an increase in bilirubin level; 1.56% were operated on because of a previous episode of jaundice with normal bilirubin at admission; 0.72% had gallbladder adenomas, 0.72% had cholangitis, 0.36% had biliodigestive fistula and one patient (0.12%) had acalculous cholecystitis. By excluding all these patients, 21.18% were operated on without indications. Conclusions The broadening of indications for laparoscopic cholecystectomy is undisputed and can be considered a consequence of new technologies that have been introduced, increased demand from patients, and the need for practice by inexperienced surgeons. If not prevented, this trend could continue indefinitely.

Stepping stones : teacher lesson plans : year 1

"ORIGO Stepping Stones gives mathematics teachers the best of both worlds by delivering lessons and teacher guides on a digital platform blended with the more traditional printed student journals." -- Publisher website

Stepping Stones A world-Class Mathematics program for the Australian Curriculum Year 1 (Student Journal)

ORIGO Stepping Stones gives mathematics teachers the best of both worlds by delivering lessons and teacher guides on a digital platform blended with the more traditional printed student journals. This uniquely interactive program allows students to participate in exciting learning activites whilst still allowing the teacher to maintain control of learning outcomes. It is the first program in Australia to give teachers activities to differentiate instruction within each lesson and across school years. Written by a team of Australia's leading mathematics educators, this program integrates key research findings in a practical sequence of modules and lessons providing schools with a step-by-step approach to the new curriculum. Click links on the right to explore the program.

Stepping stones : teacher lesson plans : year 2

"ORIGO Stepping Stones gives mathematics teachers the best of both worlds by delivering lessons and teacher guides on a digital platform blended with the more traditional printed student journals." -- Publisher website

Stepping stones : student journal : year 2

"ORIGO Stepping Stones gives mathematics teachers the best of both worlds by delivering lessons and teacher guides on a digital platform blended with the more traditional printed student journals." -- Publisher website

Stepping stones : student guide : year 3

"ORIGO Stepping Stones gives mathematics teachers the best of both worlds by delivering lessons and teacher guides on a digital platform blended with the more traditional printed student journals." -- Publisher website

Stepping stones : student journal : year K

"ORIGO Stepping Stones gives mathematics teachers the best of both worlds by delivering lessons and teacher guides on a digital platform blended with the more traditional printed student journals." -- Publisher website

Stepping stones : teacher lesson plans : year K

"ORIGO Stepping Stones gives mathematics teachers the best of both worlds by delivering lessons and teacher guides on a digital platform blended with the more traditional printed student journals." -- Publisher website

ORIGO Stepping Stones Grade K Student Journal

A mathematics curriculum for the Common Core Curriculum at the Kindergarten level for the USA