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
Processing time: 199 Days and 18 Hours
Abstract
BACKGROUND

Cholecystectomy is the preferred treatment option for symptomatic gallstones. However, another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.

AIM

To compare the feasibility, safety and effectiveness of pure natural orifice transluminal endoscopic surgery (NOTES) gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy (LC) for symptomatic gallstones.

METHODS

We adopted propensity score matching (1:1) to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones. We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020; 517 patients met the matching criteria (NOTES, 110; LC, 407), yielding 86 pairs.

RESULTS

The technical success rate for the NOTES group was 98.9% vs 100% for the LC group. The median procedure time was 119 min [interquartile ranges (IQRs), 95-175] with NOTES vs 60 min (IQRs, 48-90) with LC (P < 0.001). The frequency of post-operative pain was similar between NOTES and LC: 4.7% (4/85) vs 5.8% (5/95) (P = 0.740). The median duration of post-procedure fasting with NOTES was 1 d (IQRs, 1-2) vs 2 d with LC (IQRs, 1-3) (P < 0.001). The median post-operative hospital stay for NOTES was 4 d (IQRs, 3-6) vs 4 d for LC (IQRs, 3-5), (P = 0.092). During follow-up, diarrhea was significantly less with NOTES (5.8%) compared to LC (18.6%) (P = 0.011). Gallstones and cholecystitis recurrence 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 17.4% (n = 15/86) of patients following LC (mainly women).

CONCLUSION

NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy. This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder. Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.

Keywords: Gallstones; Trans-rectal; Natural orifice transluminal endoscopic surgery; Minimally invasive surgery; Gallbladder preservation; Cholecystolithotomy; Laparoscopic cholecystectomy

Core Tip: Laparoscopic cholecystectomy (LC) is the current gold standard for treating gallstones. However, long-term complications of LC such as duodenogastric reflux, post-cholecystectomy syndrome, bile duct injuries and an increase in colonic cancer remain largely unreported/unstudied. Some experts now advocate simple gallstone extraction with gallbladder preservation (cholecystolithotomy) in order to avoid post-cholecystectomy syndrome, bile duct injury, and its association with colon cancer. The authors’ developed the pure natural orifice transluminal endoscopic surgery trans-rectal gallbladder preserving cholecystolithotomy technique for removal of gallbladder stones. This study compared trans-rectal gallbladder preserving cholecystolithotomy with traditional LC.