Totally laparoscopic gallbladder-preserving surgery: A minimally invasive and favorable approach for cholelithiasis.

De-Kang Gao,Hao-Rong Wu,Jie Ren,Xiao-Ming Ma,Chun-Wei Gu,Shao-Hua Wei,Wei Li

doi:10.3892/etm.2014.2107

Abstract

The aim of the present study was to investigate the effectiveness of laparoscopic gallbladder-preserving surgery (L-GPS) for cholelithiasis and the feasibility and value of totally laparoscopic GPS (TL-GPS). A total of 517 patients underwent L-GPS, including 365 cases of laparoscopy-assisted GPS (LA-GPS), 143 cases of TL-GPS (preservation rate, 98.3%) and nine conversions to laparoscopic cholecystectomy. The surgeries were all performed by one medical team and the mean operating time was 72 min. All macroscopic calculi were removed through endoscopy. The number of calculi observed in the patients was between one and several dozen; diameters ranged between 0.1 and 2.5 cm. Only three cases of incisional infection were noted in the LA-GPS group and long-term follow-up showed a low recurrence rate of 1.2%. L-GPS is, therefore, an excellent approach to cure cholelithiasis and TL-GPS is a feasible and effective option that could avoid incisional complications.

Highlights

Laparoscopic gallbladder‐preserving surgery (L‐GPS), is less invasive, and endoscopic surgery makes it possible to observe the inner surface of the gallbladder, which leads to a satisfying cosmetic result and may assist with further exploration and the removal of the existing calculus
Based on an in-depth knowledge of gallbladder function [6,7], it is suggested that GPS could provide a favorable treatment option for cholelithiasis
As laparoendoscopic surgery has developed, L‐GPS combined with biliary endoscopy has been proposed by several experts in China [8]

Summary

Introduction

A large proportion of patients with typical symptoms require a laparoscopic cholecystectomy (LC), which has been regarded as the ‘gold standard’ approach for several years; the existence of postcholecystectomy syndromes [2,3] such as chronic abdominal discomfort, alkaline reflux gastritis, dyspepsia and steatorrhea, has focused attention on gallbladder preservation. Conventional open gallbladder‐preserving surgery may remove the calculus from the gallbladder but a long incision is necessary and the absence of a clear macroscopic view may lead to a high incidence of residual stone [4]. Laparoscopic gallbladder‐preserving surgery (L‐GPS), is less invasive, and endoscopic surgery makes it possible to observe the inner surface of the gallbladder, which leads to a satisfying cosmetic result and may assist with further exploration and the removal of the existing calculus

Objectives

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Conclusion