A New Strategy of Minimally Invasive Surgery for Cholecystolithiasis: Calculi Removal and Gallbladder Preservation

Abstract

Background: Cholecystolithiasis is a common disease. Cholecystectomy is the main treatment method but is associated with various complications in some patients. This study explores a novel, minimally invasive surgery for the removal of calculi and the preservation of the gallbladder using a laparoscope combined with the soft choledochoscope. Method: A retrospective analysis was conducted between January 2010 and December 2012 in 65 patients with cholecystolithiasis who underwent the minimally invasive surgery for calculi removal and gallbladder preservation. Results: In 61 cases of gallstone removal, the gallbladder was preserved perfectly with no complications. The other 4 cases were switched to laparoscopic cholecystectomy because of tiny stones blocking the cystic duct or submucosal stones. The success rate was 93.8%. Follow-up included both clinical assessment and ultrasound examination every 6 months after the operation. The patients with preoperative symptoms were symptom-free, and gallbladder function was well preserved. The overall stone recurrence rate was 4.92% at a mean follow-up of 26 months (range 6-40). Conclusions: Using the laparoscope combined with the soft choledochoscope for gallbladder-preserving cholecystolithotomy can remove stones, preserve gallbladder function, and effectively avoid the various complications of cholecystectomy. In our follow-up, gallbladder function was not affected and the stone recurrence rate was quite low.

Laparoscopic Gallbladder Preserving Surgery: Case Report

“…The reason of the decline in reccurence rate is not stated clearly in the literature but the careful patient selection and meticulous surgical technique should be the reason for the decline of recurrence rates. [4] Our patients who wished save their gallbladder, had no family history of gallstones, no acute cholecystitis and choledocolithiasis. We used preoperative USG for the evaluation of the gallbladder features (Gallbladder wall thickness, gallstone size, gallbladder volume) performed by a radiologist.…”

“…With the development of more effective minimally invasive techniques and meticulous patient selection, recurrence and complication rates of cholecystolithotomy has changed. [4] The contraindications of LGPS were as follows: (1) acute cholecystitis (2) malformed cystic duct (3) gallbladder atrophy (4) malignant biliary tumor (5) obstruction of cystic duct or common bile duct (6) biliary pancreatitis. Indications of LGPS are more important prior to surgery for careful selection of patients.…”

Cholecystolithotomy, a new approach to reduce recurrent gallstone ileus

“…Cholecystolithotomy might not be a commonly used procedure in modern surgery, however, it used to be the standard treatment of cholecystitis until cholecystectomy became a safe procedure in the late 19th century . It has also been adopted as a treatment option for cholecystitis in unfit patients or as a gallbladder preservation procedure . A recent meta‐analysis reported a gallstone recurrence rate of 3% during an average follow‐up duration of 4 years following laparoscopic cholecystolithotomy .…”

Transumbilical single-incision laparoscopic cholecystectomy: long-term review from a single center

“…In fact, the post-cholecystectomy diarrhea continued to decrease with time during long-term follow-up. Calculi and/or polyp removal with gallbladder preservation through minimally invasive surgery seemed to be an alternative choice for the patients if normal function of the gallbladder was diagnosed, which might greatly decrease the risk of diarrhea with the gallbladder function well preserved [57].…”