Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.470
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
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.
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.
To compare the feasibility, safety and effectiveness of pure NOTES gallbladder-preserving cholecystolithotomy vs LC for symptomatic gallstones.
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.
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.
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.
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.