Reconsideration of indications for choledochoscopic gallbladder-preserving surgery and preventive measures for postoperative recurrence of gallstones.

Abstract

Introduction: The recurrence of cholecystolithiasis after choledochoscopic gallbladder-preserving surgery is a major problem. It is unclear whether the recurrence of cholecystolithiasis is due to the limitations of the operation itself or to the selection of inappropriate candidates. Aim: To analyze the recurrence of cholecystolithiasis after choledochoscopic gallbladder-preserving surgery and to provide guidance for the treatment of cholecystolithiasis by choledochoscopic gallbladder-preserving surgery. Material and methods: A total of 145 patients who had undergone choledochoscopic gallbladder-preserving surgery were studied from January 2012 to January 2018. The recurrence rate, recurrence time, and risk factors were evaluated. Results: Of these 145 patients, 14 (9.66%) experienced recurrence with a mean follow-up time of 39.72 ±24.44 months. The mean time to recurrence was 30.07 ±21.21 months. Univariate analysis showed that pregnancy history (p = 0.008), the uniformity of gallstones (p = 0.002), preoperative inflammation (p = 0.022), postoperative oral drugs (p = 0.022) and the regularity of diet (p = 0.001) were significantly related to recurrence. The uniformity of gallstones (odds ratio (OR) = 0.079; 95% confidence interval (CI): 0.010-0.590; p = 0.013) and the regularity of diet (OR = 0.074; 95% CI: 0.010-0.528; p = 0.009) were independent prognostic factors for recurrence according to multivariate analysis. Conclusions: Nonuniform gallstones combined with an irregular diet are significant risk factors that predict cholecystolithiasis recurrence.

Changes in Gallbladder Contractile Function and its Influencing Factors After Minimally Invasive Gallbladder-Preserving Surgery for Cholecystitis With Incarcerated Gallstones

“…Despite these advantages, the recurrence of gallstones is a significant problem related to minimally invasive GPS, causing patients a lot of worry. To solve this problem, many researchers have sought preventive measures for stone recurrence ( 8 ).…”

Transumbilical gallbladder-preserving lithotomy via natural orifice transluminal endoscopic surgery: Retrospective 7-case series on patients with cholecystolithiasis

“…Most of our patients had a BMI more than 25 kg/m 2 . For these patients, preoperative and postoperative management of weight should be carried out to prevent stone recurrence, which is also the direction of our further efforts in management of patients in the future [13].…”

Risk Factors for Early Recurrence of Gallstones in Patients Undergoing Laparoscopy Combined With Choledochoscopic Lithotomy: A Single-Center Prospective Study

“…With surgeons' accumulated experience in this area and the development of a proposed clinical guideline in recent decades, laparoscopy combined with choledochoscopic lithotomy has been gradually proven to be safe and effective with a relatively low rate of gallstone recurrence ( 15 , 16 ). A recent retrospective study ( 17 ) showed that the overall recurrence rate of cholecystolithiasis was 9.66% among 145 patients after choledochoscopic gallbladder-preserving surgery with a median follow-up of 36 months, and the estimated 5-year recurrence rate for all patients was 12.5%. Our research group found that most cases of gallstone recurrence occurred within 2 years postoperatively, in line with a previous report ( 18 ).…”