An association between gastric surgery and gallstones has been suggested but conflicting conclusions are found in the literature. A prospective study of 118 patients with proved duodenal ulcer disease has been undertaken to determine the true incidence of gallbladder disease. Sixty-one patients undergoing surgery and 57 patients treated medically were matched for age, sex and weight. All patients had oral cholecystography at entry into the study and at 18 months and 109 were reviewed radiologically at 3 years. Three patients in the surgical group developed asymptomatic gallstones whereas none were detected in the medical group. This gives an incidence of gallstones of 4.9 per cent 3 years after gastric surgery. These findings are discussed.

As general surgeons in the UK National Health Service (NHS), we are operating in a time of uncertainty as a result of the debate on centralization and sub-specialization of our profession. The impetus for change (Expert Advisory Group to the Chief Medical Officers of England and Wales, 1995), exemplified by vascular and breast, is improvement in outcome; the rationale is that surgeons with large single-procedure workloads yield better results. However, this controversial process, together with proposed senior house officer reforms (Department of Health, 2003), has major implications on the provision of elective and emergency services.