Abstract:
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.
