Is laparoscopic cholecystectomy appropriate in low-income countries?
As explained above (see 3. Epidemiology) gallbladder disease is not a common condition in most communities of Africa. A Medline literature search of 1996-2007 database combining Laparoscopic cholecystectomy (4570 citations) with Africa or the developing world (49976 citations) yielded only 13 citations. Despite this, there is enormous interest/pressure to introduce LC in low-income countries. Surgeons in these countries naturally want to apply the most modern techniques. Thomson in a series from South Africa was able to enroll 50 patients per year, in a study, comparing OC and LC retrospectively. (47) Major duct injuries were actually more common in the OC group and mortality rates were equivalent. The conversion rate was a high 17%. Chauhan in a report of 373 patients operated on in India in 1 year demonstrated the feasibility of day care LC. (48) In a report from Mexico in 2004, the LC rate in public hospitals was 50% compared to 90% in private hospitals. (49) In this author’s opinio
