Studies suggest that the rate gallstone disease in Africa is low. previous studies suggested an increase in gallstone rates and cholecystectomies related to urbanization and the adoption of Western lifestyle habits. this study examined cholecystectomy rates for gallstone disease in South Africa (SA). An audit of cholecystectomies in SA was done by reviewing gallbladder specimens processed by the SA National Health Laboratory Service (NHLS) from 2004 and 2014. Urbanization rates were obtained from Statistics South Africa and BMi data from previously published studies. fisher's exact test, t test's and pearson's R were used for comparisons; cholecystectomy rates were calculated per 100,000 population. 33,467 cholecystectomy specimens were analysed. There was a 92% absolute increase in cholecystectomies during the study period (Pearson r 0.94; p < 0.01) with the overall cholecystectomy rate increasing by 65% from 8.36 to 13.81 per 100,000 population. The data was divided into two equal periods and compared. During the second period there was a 28.8% increase in the number cholecystectomies and patients were significantly younger (46.9 vs 48.2 years; p ≤ 0.0001). The Northern Cape was the only province to show a decline in the cholecystectomy rate in this period and was also the only province to record a decline in urbanization. population based studies in SA demonstrate increases in BMi and an association with increased urbanization. this nationwide African study demonstrates a sustained increase in cholecystectomies for gallstone disease. increases in BMi and urbanization may be responsible for this trend. Gallbladder disease is a common and costly pathology. The development of gallstones varies among population groups around the world 1. In developed societies the rate of gallstone disease averages between 10 and 15%. The risk of developing symptomatic disease is approximately 2-3% per year and 10% five years after the development of stones 1. There is a causal association between changes in dietary intake, increases in body mass index (BMI) and symptomatic cholelithiasis 2. In the last thirty years the burden of disease has increased by more that 20% in the United States 1. In the paediatric population this increase has been attributed to increases in BMI 3. Population based studies have also identified an increased BMI as a risk factor for subsequent cholecystectomy 4. As a result the number of procedures for gallstone disease has risen with cholecystectomy becoming the most common elective surgical procedure in the United States 1. Two South African epidemiological studies completed during the 1980′s suggested that the rate of gallstone disease in the black "urban" African population was low 5,6. It was noted, however, that there was an increasing trend of patients with gallstone disease and the number of cholecystectomies being performed 5,6. An increasing exposure to a Western lifestyle was cited as the potential causal association. We hypothesized that the cholecystectomy rate for gallstone related disease h...

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All procedures were performed by a single experienced surgeon, under general anaesthesia. Results: 37 patients (77%) were female. The mean age was 50.2 years(range:18-80). The mean BMI was 22.9(range:19.0-28.1). 7 patients need additional ports (1 port added in 3 patients, 2 ports added in 4 patients). This corelate with higher Cusheiri scale for difficulty. The conversion rates is 14.6%. The mean operating time was 82.3 minutes (range:40-170). The operating time varies widely partly due to technical difficulty and patient's factor. This is also reflected by the long learning curve. The mean score for post operative pain was 3.3 (range:0-7) and none reported pain that interrupted daily activities. At 2 weeks follow-up, patients were highly satisfied with resultant scar. The mean satisfaction score was 8.9 (range 7-10).4 patients (8.3%) developed grade 1 SSI at the umbilicus, which resolved with frequent dressing. Conclusion: SILC is technically challenging compared to conventional laparoscopic cholecystectomy. We conclude this technique is safe and feasible with high patients' satisfaction for cosmesis and less post-operative pain.

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