Since laparoscopic cholecystectomy eclipsed the open procedure in the early 1990s there has been a worldwide increase in annual cholecystectomy rates of between 20% and 50%.1 ,2 This has occurred despite a lack of evidence that gallstone incidence has increased to the same degree. Laparoscopic cholecystectomy has a lower mortality rate than open cholecystectomy, but in view of the increased cholecystectomy rate, there may be no decrease in the total number of deaths associated with this operation.1 Changed indications for a safer procedure and patient or physician induced demand may explain the increased cholecystectomy rate. Patients and doctors may have a lower threshold for tolerance of gallstone associated symptoms than in the pre-laparoscopic era. As gallstones may be associated with a spectrum of symptoms, from none at all to those associated with life-threatening complications, in many instances the decision to operate may be arbitrary. This is especially so as the large majority of gallstones are asymptomatic, and these are best left undisturbed.3

Patient surveys two to 24 months after both …