Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the

Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.

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and the majority of patients have acute ulcers (65 per cent)'. NSAIDs are a common aetiological factor. Although the incidence of H. pylon has been shown to be independent of sex it correlates closely with socioeconomic class, with an increased incidence in the lower socioeconomic groups'. This fact may account for the high proportion of patients infected with H. pylon in this study. In their study from Glasgow, Reinbach et aL3 found that only 47 per cent of patients presenting with acute perforated duodenal ulcer were positive for H. pylori, as opposed to 50 per cent of control patients. Thus, we agree that management of these patients should include closure of their perforation and therapy aimed at healing the ulcer. However, based on the present evidence it would not be cost-effective blindly to attempt to eradicate H. pylon in acute perforated duodenal ulcers as there is no evidence to suggest that it plays a specific role in their pathogenesis.A. G. Patel S. J. Price P. U. Reber Norfolk and Nonvich Health Care NHS. Tmst Brunswick Road Nonvich Norfolk NRl3SR UK 1 Watkins RM, Dennison AR, Collin J. What has happened to perforated peptic ulcer? Br J Surg 1984; 71: 774-6. 2 Graham DY, Malty HM, Evans DG, Evans DJ Jr, Klein PD, Adam E. Epidemiology of Helicobacter pylon in an asymptomatic population in the United States. Effect of age, race and socioeconomic status. Gastroenterology 1991; 1 0 0 3 Reinbach DH, Cruickshank G, McColl KEL. Acute perforated duodenal ulcer is not associated with Helicobacter pylon infection.

Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

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There seems to be no evidence of an increased risk of postoperative or perioperative complication in patients undergoing the Whipple procedure, with a celiac stenosis of up to 60%.