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Laparoscopic cholecystectomy after endoscopic trans-papillary gallbladder stenting for acute cholecystitis: a pilot
Fumihiro Kawano1, Ryuji Yoshioka1, Yu Gyoda1
1Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Insights
Endoscopic trans-papillary gallbladder stenting (ETGBS) is a feasible alternative to percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute cholecystitis awaiting surgery. This approach does not hinder subsequent laparoscopic cholecystectomy, offering a potential quality-of-life improvement.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Minimally Invasive Procedures
Background:
- Acute cholecystitis (AC) management often involves percutaneous transhepatic gallbladder drainage (PTGBD) for non-surgical candidates.
- External drainage tubes from PTGBD can negatively impact patient quality of life (QOL).
- Laparoscopic cholecystectomy is the preferred surgical approach for AC.
Purpose of the Study:
- To evaluate the feasibility of laparoscopic cholecystectomy following endoscopic trans-papillary gallbladder stenting (ETGBS).
- To compare ETGBS with PTGBD in patients with AC awaiting elective surgery.
Main Methods:
- Retrospective comparison of intraoperative and postoperative outcomes.
- Analysis included 18 patients who underwent ETGBS and 10 patients who underwent PTGBD.
Main Results:
- No significant differences were observed in procedure duration, blood loss, conversion to laparotomy, or postoperative hospital stay between ETGBS and PTGBD groups.
- Cystic duct thickening occurred in 60% of ETGBS patients, potentially complicating duct closure.
- No instances of obstruction were reported in the ETGBS group.
Conclusions:
- Endoscopic trans-papillary gallbladder stenting (ETGBS) appears feasible for laparoscopic cholecystectomy, similar to PTGBD.
- Further research is necessary to confirm these preliminary findings and validate ETGBS as a viable alternative.
Background:
Percutaneous transhepatic gallbladder drainage (PTGBD) is indicated for patients with acute cholecystitis (AC) who are not indicated for urgent surgery, but external tubes reduce quality of life (QOL) while waiting for elective surgery. The objective of the present study was to investigate the feasibility of laparoscopic cholecystectomy after endoscopic trans-papillary gallbladder stenting (ETGBS) comparing with after PTGBD.
Methods:
Intraoperative and postoperative outcomes of patients with ETGBS and PTGBD were retrospectively compared.
Results:
Eighteen ETGBS and ten PTGBD patients were compared. Differences in the duration of ETGBS and PTGBD [median 209 min (range 107-357) and median 161 min (range 130-273), respectively, P = 0.10], median blood loss [ETGBS 2 (range 2-180 ml) and PTGBD 24 (range 2-100 ml), P = 0.89], switch to laparotomy (ETGBS 11% and PTGBD 20%, P = 0.52), and median postoperative hospital stay [ETGBS 8 (range 4-24 days) and ETGBS 8 (range 4-16 days), P = 0.99]. Thickening of the cystic duct that occurred in 60% of the ETGBS patients and none of the PTGBD patients (P = 0.005) interfered with closure of the duct by clipping. No obstruction occurred in ETGBS patients.
Conclusion:
ETGBS did not make laparoscopic cholecystectomy less feasible than after PTGBD. This is a pilot study, and further investigations are needed to validate the results of the present study.
