Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable?A propensity matched study  

作　　者：Saif Ullah Bao-Hong Yang Dan Liu Xue-Yang Lu Zhen-Zhen Liu Li-Xia Zhao Ji-Yu Zhang Bing-Rong Liu 

机构地区：[1]Department of Gastroenterology and Hepatology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China [2]Department of Oncology,Weifang People's Hospital,Weifang 261000,Shandong Province,China [3]State Key Laboratory of Esophageal Cancer Prevention and Treatment,Zhengzhou University,Zhengzhou 450052,Henan Province,China

出　　处：《World Journal of Gastrointestinal Surgery》2022年第5期470-481,共12页世界胃肠外科杂志（英文版）（电子版）

基　　金：Supported by Outstanding Foreign Scientist Studio Project of Henan Province,No.GZS2020006.

摘　　要：BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones.However,another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.AIM To compare the feasibility,safety and effectiveness of pure natural orifice transluminal endoscopic surgery(NOTES)gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy(LC)for symptomatic gallstones.METHODS We adopted propensity score matching(1:1)to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones.We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020;517 patients met the matching criteria(NOTES,110;LC,407),yielding 86 pairs.RESULTS The technical success rate for the NOTES group was 98.9%vs 100%for the LC group.The median procedure time was 119 min[interquartile ranges(IQRs),95-175]with NOTES vs 60 min(IQRs,48-90)with LC(P<0.001).The frequency of post-operative pain was similar between NOTES and LC:4.7%(4/85)vs 5.8%(5/95)(P=0.740).The median duration of post-procedure fasting with NOTES was 1 d(IQRs,1-2)vs 2 d with LC(IQRs,1-3)(P<0.001).The median post-operative hospital stay for NOTES was 4 d(IQRs,3-6)vs 4 d for LC(IQRs,3-5),(P=0.092).During follow-up,diarrhea was significantly less with NOTES(5.8%)compared to LC(18.6%)(P=0.011).Gallstones and cholecystitis recurrence 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 17.4%(n=15/86)of patients following LC(mainly women).CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy.This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder.Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.

关 键 词：GALLSTONES Trans-rectal Natural orifice transluminal endoscopic surgery Minimally invasive surgery Gallbladder preservation CHOLECYSTOLITHOTOMY Laparoscopic cholecystectomy 

分 类 号：R657.4[医药卫生—外科学]