Many cholelithiasis patients resist cholecystectomy, which has prompted surgeons to assess a new treatment option for gallstones, which preserves the gallbladder, termed choledochoscopic gallbladder-preserving cholecystolithotomy. 

The recent study reviewed the clinical outcomes of 23 years of single-center application of choledochoscopic gallbladder-preserving cholecystolithotomy.

It selected 5,451 patients with chronic cholelithiasis and collected clinicopathological and follow-up data from 4,340 patients who underwent successful choledochoscopic gallbladder-preserving cholecystolithotomy. In the follow-up, the study assessed recurrence of stones, loss to follow-up, patient death, removal of the gallbladder for other reasons, or end of follow-up.

The study observed-

• Four thousand three hundred forty cases underwent choledochoscopic gallbladder-preserving cholecystolithotomy with a mean procedure time of 79.6 ± 35.4 minutes.
• 80.9% of the patients received at least one follow-up.
• A gradual increase in the recurrence rate of gallstones with increasing follow-up duration.
• The recurrence rate as 0.83% within one year after surgery, and a maximal cumulative recurrence rate as 7.94% at 23 years.
• The age group ≤20 years described the 5-year cumulative recurrence rate of gallstones as 16.80%, which was significantly higher than other age groups, and the 5-year recurrence rate in the single gallstone group as 2.87%, which was significantly lower than the multiple gallstone group.
• Age and number of gallstones as the independent risk factors for gallstone recurrence after the surgery.

This study shows a low recurrence rate of gallstones after choledochoscopic gallbladder-preserving cholecystolithotomy, and that majority of the patients with recurrence are asymptomatic or have only mild symptoms. Age and number of gallstones are the independent risk factors. Choledochoscopic gallbladder-preserving cholecystolithotomy is a safe and effective surgical option for gallstone removal in patients resisting to undergo cholecystectomy.

Source: Liu J, Zhu X, Zhao Q, Huang K, Zhou D, Zhang X, Gao Z, Liu S, Gu J. 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. Epub 2022 Sep 8. PMID: 36089424.