Authors’ Reply: Routine Pathology and Postoperative Follow-Up are not Cost-Effective in Cholecystectomy for Benign Gallbladder Disease
We would like to thank Garg et al. for their comments on our recent article.  None of the included patients had a preoperative suspicion of gallbladder cancer (GBC) nor was there an intraoperative suspicion GBC in any of the patients. Therefore, the four diagnoses of GBC in the study can be considered incidental gallbladder carcinomas.
We agree the incidence of gallbladder cancer  and other biliary malignancies  varies between the Eastern and Western parts of the world. Therefore, the conclusion from our analysis that suggests a selective approach by sending only macroscopically abnormal gallbladders specimens for pathology might only be applicable to Western centers. A large prospective nationwide study that could conform these results is currently recruiting and might also tell us whether surgeons can sufficiently macroscopically examine gallbladder specimens. 
Whether it is the patients’ decision to send a resected specimen for pathology or not is an interesting discussion. We do not agree with Garg et al.; it should be left to the patient. Although the decision to send a specimen for pathology must be carefully considered for every patient, we as doctors also have a responsibility toward society here. Uncertainty is unfortunately an inseparable part of medicine, but cost-effectiveness is essential to keep healthcare systems affordable. In our opinion, ‘defensive medicine’ and ‘ask, and you shall receive’ should not be part of modern medicine.
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