---
title: Gallbladder surgery in South Korea: what the evidence says about who gets operated on, how safely, and what happens next
publication: Medical Insights Korea
section: news
category: Gallbladder
canonical_url: https://medicalinsightskorea.com/news/gallbladder-surgery-in-south-korea
author: James Choi
published: 2026-09-01T15:40:00+09:00
modified: 2026-09-01T15:40:00+09:00
content_type: reporting
license: Quotation permitted with attribution to Medical Insights Korea and a link to the canonical URL.
---

# Gallbladder surgery in South Korea: what the evidence says about who gets operated on, how safely, and what happens next

Korea removes three times as many gallbladders as it did fifteen years ago. This is what the published evidence establishes about that operation, and where it runs out.

## Answer

South Korea's age-standardised cholecystectomy rate rose from 67.7 to 211.4 per 100,000 between 2003 and 2017, bile duct injury occurs in about 0.7 percent of operations across 18 Korean academic institutions, and most people live normally afterwards, with roughly 13 percent developing diarrhoea and about 3 percent persistent post-surgical symptoms.

## Key takeaways

- South Korea's age-standardised cholecystectomy rate rose from 67.7 to 211.4 per 100,000 between 2003 and 2017, and the authors of the national claims study named increasing computed tomography use as a probable primary cause.
- Most gallstones that have never caused symptoms never do: about 10 percent become symptomatic within five years and 19 percent within ten.
- Bile duct injury, the complication that matters most, occurred in 17 of 2,514 operations (0.7 percent) in a prospective study across 18 Korean academic institutions.
- Draining an inflamed gallbladder before surgery instead of operating directly was associated in matched Korean series with about a week more in hospital and roughly double the intensive care admission, without fewer complications.
- Korean national cohorts report raised rates of several later diagnoses after cholecystectomy, but the largest found the excess concentrated one to three years after surgery and back to the control level by five to ten — the shape of detection rather than of cause.

## Full article

Cholecystectomy is one of the most common operations performed in South Korea, and one of the least examined in public. This article collects what the published evidence establishes about it, links to our reporting on each part, and is explicit about the places where the question a patient is actually asking has no Korean answer yet.

### How many, and why the number moved

Between 2003 and 2017 the age-standardised rate of cholecystectomy in Korea rose from 67.7 to 211.4 per 100,000 — more than tripling in fifteen years, after adjusting away the effect of an ageing population. The authors of that nationwide claims study identify increasing use of computed tomography as a probable primary cause: a scan ordered for something else finds a stone, and a recorded finding is difficult to leave alone.

**67.7 → 211.4** — age-standardised cholecystectomies per 100,000 in South Korea, 2003 to 2017  
_Source: Jeon CH et al., Annals of Surgical Treatment and Research, 2022_

What that trend cannot show is whether the additional operations were necessary. Insurance claims do not record whether a patient had symptoms, so the data establishes that Korea operates far more often than it did and stops there.

### Who needs an operation

For gallstones that have never caused symptoms, the pooled evidence is reassuring: about 10 percent become symptomatic within five years, 19 percent within ten and 26 percent within fifteen, and the authors of that meta-analysis recommend conservative management for most patients.

For gallbladder polyps, Korea is deliberately out of step with Europe. The Korean Society of Abdominal Radiology moved the size at which surgery is firmly recommended from 10 mm to 15 mm in January 2025; the European joint guideline still recommends surgery at 10 mm, and radiologists in Beijing challenged the Korean change in print within eight weeks.

**Reported in full**

- [Cholecystectomies in Korea more than tripled in fifteen years. The national study points at CT scanners](https://medicalinsightskorea.com/news/korea-cholecystectomy-rate-tripled-ct)
- [Korean radiologists raised the gallbladder polyp surgery threshold to 15 mm. Now they are defending it in print](https://medicalinsightskorea.com/news/ksar-gallbladder-polyp-threshold-challenged)
- [Do I need surgery if I have gallstones but no symptoms?](https://medicalinsightskorea.com/faq/asymptomatic-gallstones-need-surgery)
- [At what size does a gallbladder polyp need surgery?](https://medicalinsightskorea.com/faq/gallbladder-polyp-size-for-surgery)

### When the gallbladder is acutely inflamed

The Tokyo Guidelines 2018, whose authors include Korean hepatobiliary surgeons, recommend early laparoscopic cholecystectomy for grade I and grade II disease in patients whose comorbidity and anaesthetic risk are within defined limits, reserving drainage for those outside them. The guideline also abandoned the older 72-hour window; early now means within seven days.

Korean practice frequently drains first. Matched Korean series find that this costs about a week of hospital stay and roughly doubles intensive care admission without reducing complications — and that the delay which independently predicted harm was the patient's own, not the surgeon's: presenting more than four days after symptoms began tripled the odds of a postoperative complication.

**Reported in full**

- [Draining the gallbladder before surgery added a week in hospital and doubled ICU admission. It did not reduce complications](https://medicalinsightskorea.com/news/ptgbd-before-cholecystectomy-korean-outcomes)

### How safe the operation is

The Korean number comes from a prospective study across 18 academic institutions: of 2,514 patients, 62 (2.5 percent) had a surgery-related complication and 17 (0.7 percent) sustained a bile duct injury. That figure is reassuring in aggregate and severe in the individual case — an Irish national cohort of patients who needed surgery for such an injury reported reconstruction in 76 percent, reoperation in 29 percent, one liver transplant and three deaths.

**Reported rates across the operation and its aftermath**

| Measure | Rate | Population |
| --- | --- | --- |
| Bile duct injury | 0.7% | 2,514 patients, 18 Korean institutions |
| Surgery-related complications | 2.5% | same cohort |
| Diarrhoea afterwards | 13.3% | 3,476 pooled patients, 21 studies |
| Persistent post-surgical symptoms | 3.21% | 2,948 pooled patients, 9 studies |

When a gallbladder cannot be safely removed whole, surgeons increasingly leave part of it behind rather than converting to open surgery. That substitution is well justified — bile duct injury in 0.3 percent — and is not free: overall complications of 24.7 percent, readmission of 17.8 percent, and one patient in six returning for an endoscopic procedure.

Whether the robot is safer than the laparoscope is genuinely unresolved. Two meta-analyses published weeks apart reached opposite conclusions on bile duct injury, and the larger one's confidence interval is wide enough to contain the other's estimate — an imprecise result rather than a reassuring one.

**Reported in full**

- [Korea now has its own number for the worst thing that can go wrong in gallbladder surgery: 0.7 percent](https://medicalinsightskorea.com/news/korea-cholecystectomy-bile-duct-injury-rate)
- [Surgeons stopped escaping difficult gallbladders by opening the abdomen. What they do instead is safer for the bile duct and harder on everything else](https://medicalinsightskorea.com/news/difficult-gallbladder-bailout-subtotal-vs-conversion)
- [Two meta-analyses published weeks apart disagree about whether robotic gallbladder surgery injures more bile ducts. Read the confidence intervals](https://medicalinsightskorea.com/news/robotic-cholecystectomy-evidence-disagreement)

### What happens afterwards

The liver keeps producing bile; what changes is that it drains continuously instead of being stored and released after meals. Roughly one patient in eight develops diarrhoea, and about 3 percent have persistent abdominal symptoms, most strongly predicted by having had symptoms before the operation.

Korea's national insurance database has generated a series of studies reporting higher rates of later diagnoses after cholecystectomy — cancer, type 2 diabetes, chronic kidney disease, depression. The largest, comparing 715,872 operated patients against 1,431,728 matched controls, found the excess concentrated one to three years after surgery and back to the control level after five to ten. A cause working through altered bile physiology would accumulate rather than fade, and its authors titled the paper increased diagnosis rather than increased incidence.

**Reported in full**

- [Korean national data keeps finding new diseases after gallbladder removal. When those diseases appear tells a different story](https://medicalinsightskorea.com/news/cholecystectomy-later-disease-korean-cohorts)
- [Can you live normally without a gallbladder?](https://medicalinsightskorea.com/faq/life-without-a-gallbladder)
- [Why do I have diarrhoea after gallbladder surgery?](https://medicalinsightskorea.com/faq/post-cholecystectomy-diarrhoea)

### Where the Korean evidence runs out

1. No published Korean series reports conversion or subtotal cholecystectomy outcomes at national scale, so those figures in our reporting are Irish, Chilean, American and European and are labelled as such.
2. The Korean bile duct injury rate of 0.7 percent comes from 18 academic institutions. Smaller hospitals are not represented and there is no basis for assuming the rate is the same there.
3. The Korean risk calculator built on that cohort rests on 17 injury events and has been developed rather than validated in an independent population.
4. Whether Korea's tripled operating rate reflects more disease, more detection, or more intervention on incidental findings is not answerable from claims data, which does not record whether a patient had symptoms.

> **How this page is maintained**  
> This is the overview for our gallbladder reporting and is updated as pieces are added or as the underlying evidence changes; the modification date at the top of the page reflects the last such change. Every figure on it is drawn from a source listed below and reported in full in the linked article.

## Sources

- Jeon CH, Hong J, Jung J, Moon JY, Seo HS. Chronological trends in patients undergoing cholecystectomy in Korea: a nationwide health insurance claims study. Annals of Surgical Treatment and Research 2022;102(4):205-213. doi:10.4174/astr.2022.102.4.205. PMID:35475231. https://doi.org/10.4174/astr.2022.102.4.205
- Lee H, Han IW, Choi JE, Lee HK. Surgical risk calculator development for postoperative outcomes after laparoscopic cholecystectomy: a multicenter prospective cohort study. Annals of Surgical Treatment and Research 2025;108(6):352-361. doi:10.4174/astr.2025.108.6.352. PMID:40503269. https://doi.org/10.4174/astr.2025.108.6.352
- Lee KJ, Jung JH, Park SW, Park DH, Cha HW, Koh DH, et al. Clinical impact of percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy in patients with moderate to severe acute cholecystitis: A propensity score-matched case-control study. American Journal of Surgery 2026;252:116737. doi:10.1016/j.amjsurg.2025.116737. PMID:41317682. https://doi.org/10.1016/j.amjsurg.2025.116737
- Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences 2018;25(1):55-72. doi:10.1002/jhbp.516. PMID:29045062. https://doi.org/10.1002/jhbp.516
- Kim YA, Kim HJ, Kang MJ, Han SS, Park HM, Park SJ. Increased diagnosis of hepato-biliary-pancreatic cancer after cholecystectomy: a population-based study. Scientific Reports 2025;15(1):411. doi:10.1038/s41598-024-84781-7. PMID:39747399. https://doi.org/10.1038/s41598-024-84781-7
- Farrugia A, Attard JA, Khan S, Williams N, Arasaradnam R. Postcholecystectomy diarrhoea rate and predictive factors: a systematic review of the literature. BMJ Open 2022;12(2):e046172. doi:10.1136/bmjopen-2020-046172. PMID:35177439. https://doi.org/10.1136/bmjopen-2020-046172
- Zhou H, Xuan F, Liu M. Incidence risk and risk factors for postcholecystectomy syndrome: A systematic review and meta-analysis. Medicine 2026;105(7):e47687. doi:10.1097/md.0000000000047687. PMID:41686575. https://doi.org/10.1097/md.0000000000047687
- Nadeem MA, Awan AR, Wehrle CJ, Tsutsumi A, Darby F, Bhandarkar S, et al. Operative strategies for the acute difficult gallbladder: a Society for Surgery of the Alimentary Tract state-of-the-art systematic review and meta-analysis of subtotal cholecystectomy outcomes. Journal of Gastrointestinal Surgery 2026;30(4):102345. doi:10.1016/j.gassur.2026.102345. PMID:41644007. https://doi.org/10.1016/j.gassur.2026.102345
- Alzoubi M, Omar Saleh A, Omari FA, Shatnawi K, Hyari B, Qashou A, et al. Asymptomatic gallstones: Cumulative incidence proportion, incidence rate, and risk factors for symptoms development: Systematic review and meta-analysis. PLOS ONE 2026;21(3):e0345462. doi:10.1371/journal.pone.0345462. PMID:41886405. https://doi.org/10.1371/journal.pone.0345462
- Mullen C, O'Connell RM, Walsh J, Fullard A, Hardy N, O'Sullivan A, et al. Patient outcomes and healthcare costs following iatrogenic bile duct injuries: A national multicentre retrospective cohort study. Annals of Hepato-Biliary-Pancreatic Surgery 2025;29(4):441-448. doi:10.14701/ahbps.25-141. PMID:41198047. https://doi.org/10.14701/ahbps.25-141

## Citation

James Choi (2026). "Gallbladder surgery in South Korea: what the evidence says about who gets operated on, how safely, and what happens next". Medical Insights Korea. https://medicalinsightskorea.com/news/gallbladder-surgery-in-south-korea

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