Gallbladder-preserving cholecystolithotomy

ABSTRACT

Introduction

Cholecystectomy is the preferred option for symptomatic gallstones. Gallbladder-preserving cholecystolithotomy (GPC) is proposed to satisfy the specific surgical patients with high-risks, biliary deformity and suffered from concomitant gallstone and choledocholithiasis.

Areas covered

This review summarizes and compares the various GPC operations for cholelithiasis in some specific cases.

Expert opinion

Transmural GPC mainly focuses on the gallstones, including endoscopic minimally invasive cholecystolithotomy (EMIC)-, natural orifice transluminal endoscopic surgery-, and endoscopic ultrasonography (EUS)-GPC. These GPC procedures potentially preserve gallbladder integrity and function after clearance of gallstones. Additionally, transmural GPC may overcome the disadvantages of cholecystectomy, including cosmetic considerations and postoperative complications. However, the stone recurrence rate of EMIC varies greatly from 4.92% to 40.0%, and based on limited studies, long-term adverse events due to gallbladder mucosa and natural lumen injury are largely unknown in transmural GPC. Thus, transmural GPC may be an alternative to cholecystectomy for surgical patients with high-risks and abnormal biliary anatomy. Endoscopic retrograde cholangiopancreatography-based transcystic GPC may be promising for some specific patients with concomitant gallstones and choledocholithiasis, since gallbladder integrity and function may be completely preserved as the gallbladder wall was hardly injured and the function of sphincter of Oddi was retained.

KEYWORDS:

• Gallbladder-preserving cholecystolithotomy (GPC)
• cholecystectomy
• endoscopic minimally invasive cholecystolithotomy (EMIC)
• natural orifice transluminal endoscopic surgery (NOTES)
• endoscopic ultrasonography (EUS)
• endoscopic retrograde cholangiopancreatography (ERCP)

Article highlights

• Cholecystectomy remains the preferred procedure for gallstones due to its unique merits.

• Cholecystectomy may be frustrated in surgical patients with high-risks and biliary deformity.

• Transmural GPC mainly aimed at those patients with symptomatic gallstones not candidates for cholecystectomy.

• Transmural GPC potentially preserve gallbladder function after clearance of gallstones, and have the superiority of aesthetic appearance.

• Gallstone recurrence remains the main disadvantages for EMIC.

• Little is known regarding the long-term adverse events (e.g. cholecystitis, abdominal adhesions, and gallbladder dysfunction) of transmural GPC due to gallbladder mucosa and natural lumen injury.

• ERGD has been proved to be an effective procedure for the high-risk surgical patients with severe acute cholecystitis not candidates for surgery, especially for those patients with blood coagulating dysfunction.

• ERCP-GPC may be a promising alternative for patients with normal gallbladder function suffered from concomitant gallstone and common bile duct stone.

• Gallbladder function may be completely preserved as the gallbladder wall was hardly injured and the function of sphincter of Oddi was retained as much as possible in ERCP-GPC.

• EPSBD combined with prophylactic pancreatic duct stent placement or MI-EST are performed to prevent the function of sphincter of Oddi.

• Successful cystic duct cannulation and subsequent FCMS placement mainly rely on the cystic duct patterns.

• Classification of cystic duct patterns before ERCP procedure may be helpful for optimization of operation methods.

• The long-term efficacy and safety of ERCP-GPC is needed to be verified.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by National Natural Science Foundation of China (No. 81760106) and the project of Jiangxi Province Education Department (No. GJJ190029) .