Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2022; 14(5): 470-481
Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.470
Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable? A propensity matched study
Saif Ullah, Bao-Hong Yang, Dan Liu, Xue-Yang Lu, Zhen-Zhen Liu, Li-Xia Zhao, Ji-Yu Zhang, Bing-Rong Liu
Saif Ullah, Bao-Hong Yang, Dan Liu, Xue-Yang Lu, Zhen-Zhen Liu, Li-Xia Zhao, Ji-Yu Zhang, Bing-Rong Liu, Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Bao-Hong Yang, Department of Oncology, Weifang People's Hospital, Weifang 261000, Shandong Province, China
Bing-Rong Liu, State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou University, Zhengzhou 450052, Henan Province, China
Author contributions: Liu BR, Saif U and Yang BH contributed to the design of the study, collected data and drafted the manuscript; Yang BH, Lu XY performed the data analyses and revised the manuscript; Zhao LX, Liu D, and Liu ZZ helped perform the analysis with constructive discussions; Zhang JY and Saif U contributed to manuscript preparation data for the work; Liu BR conceived the work that led to the submission and approved the final version; all authors issued final approval for the version to be submitted.
Supported by Outstanding Foreign Scientist Studio Project of Henan Province, No. GZS2020006.
Institutional review board statement: This study was reviewed and approved by the Independent Ethics Committee of the Second Affiliated Hospital of Harbin University and the First Affiliated Hospital of Zhengzhou University.
Informed consent statement: All study participants or their legal guardian provided informed written consent regarding personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bing-Rong Liu, PhD, Director, Professor, Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, Henan Province, China. fccliubr@zzu.edu.cn
Received: November 6, 2021
Peer-review started: November 6, 2021
First decision: January 9, 2022
Revised: January 18, 2022
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: May 27, 2022
ARTICLE HIGHLIGHTS
Research background

Laparoscopic cholecystectomy (LC) remains the preferred option for symptomatic gallstones. However, the gallbladder functions in regulating bile flow and storing bile, and cholecystectomy may disrupt the whole biliary system and induce subsequent complications. Simple gallstone extraction with gallbladder preservation (cholecystolithotomy) has been proposed in order to preserve gallbladder function and to avoid gallbladder resection-related complications.

Research motivation

In response to the clinical desires and importance of gallbladder retention in a large number of patients, we developed pure natural orifice transluminal endoscopic surgery (NOTES) trans-rectal gallbladder preserving cholecystolithotomy as an ultra-minimally invasive technique for removal of gallbladder stones and gallbladder preservation.

Research objectives

To compare the feasibility, safety and effectiveness of pure NOTES gallbladder-preserving cholecystolithotomy vs LC for symptomatic gallstones.

Research methods

We extracted patient data from the inpatient database and adopted propensity score matching (1:1) to compare trans-rectal NOTES cholecystolithotomy and LC in patients with symptomatic gallstones.

Research results

The technical success rate for the NOTES group vs the LC group was 98.9% vs 100%. Post-operative pain was similar between NOTES and LC; however, the median duration of fasting was less in NOTES patients. During the follow-up period, diarrhea was significantly less with NOTES (5.8%) compared to LC (18.6%). The recurrence rate of stones and cholecystitis within a median of 12 mo (range: 6-40 mo) following NOTES was 10.5% and 3.5%, respectively. Concerns regarding the presence of abdominal wall scars were present in patients following LC.

Research conclusions

NOTES appears to be a minimally invasive and feasible alternative scar-free technique for the management of patients with symptomatic gallstones. Reducing the recurrence of gallstones is essential to achieve widespread clinical adoption of NOTES.

Research perspectives

Although cholecystectomy remains the mainstay in gallstones treatment due to its unique merits, it may not be feasible in surgical patients at high-risk or with biliary deformity. In addition, since post-operative adverse events after removal of the gallbladder are inevitable in some patients, more and more endoscopists are interested in preservation of gallbladder function during the management of gallstones. Therefore, in our opinion NOTES cholecystolithotomy may be an alternative treatment for symptomatic gallstones, especially for patients wishing to avoid surgical resection.