Changing work patterns for benign upper gastrointestinal and biliary disease: 1994-2007: Upper gut surgery

Background: The evolution of surgical technology has impacted on surgical practice. We determined trends in surgical caseload for common benign biliary and uppergastrointestinal conditions in Australia over the last 15 years. Methods: Using the Medicare Australia web site, the use of Medicare item numbers specific to gall stone, bariatric and anti-reflux procedures were determined nationally and for each Australian state for each year from 1994 to 2007. Rates of operative cholangiography, laparoscopic to open cholecystectomy conversion and bile duct exploration were calculated. Per capita use of bariatric procedures was also determined. Anti-reflux surgery was analysed as total and specific subgroups of anti-reflux procedures. Results: The use of intra-operative cholangiography has increased over time, and the conversion to open cholecystectomy and application of common bile duct exploration both decreased. A rapid increase in restrictive bariatric procedures has occurred, and this has been followed by a similar increase in revision bariatric surgery and lap band adjustments. The application of anti-reflux surgery has also increased significantly with the repair of large hiatus hernia accounting for most of the increase over the last five years, whereas revision anti-reflux surgery remains uncommon. Conclusions: These data demonstrate significant increases in the application of some laparoscopic surgical techniques, particularly for morbid obesity. Future health-care planning will need to consider the impact of these changes.