Gall bladder preserving surgery is a safe and feasible option in patients with gallstones with a low postoperative recurrence rate, suggests a recent study published in the November 2022 issue of the journal Surgery.^1,2

In this study, researchers in China retrospectively examined the clinical outcomes of choledochoscopic gallbladder-preserving cholecystolithotomy, a new surgical procedure for cholelithiasis, performed at the Peking University Shougang Hospital over a period of 23 years. For this 5451 patients with gallstones were selected from 1992 to 2011. Of these, 4340 patients in whom the procedure was performed successfully were followed up to 2015. Nearly 81% (n=3511) of them had a minimum of one follow-up visit. The study endpoints were recurrence rates and postoperative complications. The mean duration of the surgery was 79.6 ± 35.4 minutes. An increase in the recurrence rate was observed as the follow-up period increased. The recurrence rate at 1-year post-surgery was 0.83% and at 23 years, the cumulative recurrence rate of gallstones was 7.94%. Compared to other age groups, the 5-year cumulative recurrence rate was almost 16.8% among participants younger than 20 years, which was much higher than those of other age groups. Patients with multiple gallstones were more likely to experience recurrence. In patients with a single gallbladder stone, the 5-year recurrence rate was less than 3% compared to those with multiple stones.

This study has demonstrated the safety and efficacy of the gallbladder preserving surgery while removing gallstones, sludge or polyps under choledochoscopy. Free flow of bile from the cystic duct into the gallbladder has to be ensured before closure. It provides an alternative to traditional cholecystectomy for those patients who do not wish to undergo removal of gallbladder. But only those patients who have a normal gallbladder are contenders for the gallbladder preserving surgery. Cholecystectomy is indicated in patients with acute cholecystitis, atrophy of gallbladder or suspected gallbladder carcinoma.

The study has also identified age of the patient and the number of gallstones as risk factors for recurrence of gallstones following choledochoscopic gallbladder-preserving cholecystolithotomy. Majority of patients who developed gallstones recurrence were either asymptomatic or only mildly symptomatic.

References

1. Liu J, et al. A new operation for gallstones: Choledochoscopic gallbladder-preserving cholecystolithotomy, a retrospective study of 3,511 cases. Surgery. 2022 Nov;172(5):1302-1308. doi: 10.1016/j.surg.2022.08.008.
2. https://www.gastroenterologyadvisor.com/cholecystitis/choledochoscopic-gallbladder-preserving-cholecystolithotomy-alternative-to-cholecystectomy/.