Evolution of Cholecystectomy-Gall Bladder must be Removed not because it Contains Stones but Forms them

Abstract

Normally, human bile contains enough chemicals to dissolve the cholesterol excreted by our liver. But if our liver excretes more cholesterol than the bile can dissolve, the excess cholesterol, too much bilirubin, or not enough bile salts, first form into crystals and eventually turn into stones when stored in the gall bladder. The estimated overall prevalence of cholelithiasis is 10–15% in the general population, with some differences across countries, ethnic and age groups. The good fact is most of the gall stone patients are asymptomatic. The prevalence of gall stones is around 6% of the total population in India, with a clear predominance among females with 10% and 3% in men. In India among 808 million adult population 81 million will suffer Cholelithiasis every year and a conservative 1.6 million (2%) of them would need surgery. Among American adults the prevalence of cholelithiasis is about 10% while in Western Europe the prevalence ranges from 5.9% to 21.9%. More than one million Americans are diagnosed with gallstones every year, joining about 38 million who already have the disorder. Cholecystectomy: the surgical resection and removal was and continues to be the permanent solution and the gold standard for the definitive management of symptomatic cholelithiasis. J. L. W Thudichum proposed a two-stage elective cholecystostomy in 1859, In the first stage, the inflamed gall bladder was sewed to the anterior abdominal wall through a small incision, to serve as a route for the removal of gall stone later in the second stage. Laparoscopic cholecystectomy (LC) since its inception in 1989 has become the gold standard treatment for gall stone disease. The technique of performing LC has undergone many changes and variations. Several surgeons have tried to reduce the size and number of ports to improve cosmetic and postoperative outcomes and developed their own different versions. The most recent development in technique of LC is single incision laparoscopic surgery (SILS) or single site laparoscopic cholecystectomy (SSLC). This review is a consequence of witnessing an elective Cholecystectomy and review of the prevailing cost across the country and health insurance coverage in India. As a public health problem Cholelithiasis can’t be prevented, and Cholecystectomy is needed to 1.6 million Indian adults each year costing a fortune. Currently it cannot be accessed by all, especially the poor and even lower middle socio-economic class. With overall, health insurance coverage of around 30%, that too among urbanites, mainly covered by employers in India is a public health challenge. Ayushman Bharat a national initiative launched on 23rd September 2018, a GOI health assurance initiative adapted by almost all State governments for providing accessible and affordable healthcare to the common man for secondary and tertiary care hospitalization is still in a nascent stage. Methodology: This review is based on an observation of Laparoscopic Cholecystectomy in a 3-star private hospital on a middle socioeconomic woman, followed by literature review and costs across India by the end of 2022.