Current Status of Laparoscopic Therapy of Cholecystolithiasis and Common Bile Duct Stones

Abstract

Background: Laparoscopic cholecystectomy (LC) is the standard operation for gallstone disease. The aim of this review was to scrutinize the advantages and benefits of this minimal invasive technique compared to the conventional operation according to the available literature. Regarding the evidence-based medicine criteria, the current status of laparoscopy in the treatment of cholecystolithiasis, cholecystitis and common bile duct stones has been worked out. Methods: A Medline, PubMed, Cochrane search. Results: Ten randomized controlled trials (RCTs) are available comparing laparoscopic versus open cholecystectomy. The superiority of LC in less postoperative pain, shorter recovery and hospital stay is stated. Operation time was longer in the first years of LC. 3 RCTs deal with acute cholecystitis: one paper could not find any significant advantage of LC over conventional cholecystectomy, the other two found benefits in recovery, hospital stay and postoperative pain. The range of conversion is between 5 and 7% in elective cases and increases up to 27% for acute cholecystitis. With a rate of more than 90% in Europe, the standard procedure for common bile duct stones is ‘therapeutic splitting’ with endoscopy and retrograde cholangiopancreatography preoperatively followed by LC. Laparoscopic bile duct clearance is effective and safe in experienced hands, however, the only proven benefit is a slightly shorter hospital stay. Conclusion: The laparoscopic approach is preferred in elective cholecystectomy and acute cholecystitis. The minimal invasive technique has proven to be effective, gentle and safe. The main benefits are evident within the first postoperative days.

Evaluation of peritoneal tissue by means of differential scanning calorimetry (DSC)

“…The modulation of the immunological system as well as the inflammatory reaction has been described by many authors [1]. Regardless of the shorter hospital stay and better cosmetic effect for the patients who undergo laparoscopic surgery, this technique is not immune from the consequences of surgical trauma [27][28][29]. Laparoscopic techniques have been continuously improved.…”

Evidence-based clinical practice guidelines for cholelithiasis 2016

“…Laparoscopic cholecystectomy is comparable to open cholecystectomy with regard to mortality and the incidence of complications [23,24], leads to a significantly shorter hospital stay, and is generally preferred as the first-choice surgical procedure (Fig. 1) [25][26][27][28]. It has been reported that 3.6-8% of laparoscopic cholecystectomies are intraoperatively switched to open procedures for a variety of reasons, including technical difficulties, biliary tract damage, anesthesia problems, and device malfunction [29][30][31][32].…”

Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study

“…These advantages include not only better cosmesis, less postoperative pain, smaller wounds, early return to normal activities, and higher patient satisfaction, but also better illumination and magnification allowing excellent visibility of minute details [1][2][3][4]. Strong enthusiasm for the technique hindered early careful evaluation of this procedure, which was later shown to entail some specific risks [5].…”

“…Strong enthusiasm for the technique hindered early careful evaluation of this procedure, which was later shown to entail some specific risks [5]. Nevertheless, LC has been established as the standard treatment for symptomatic gallbladder diseases [1].…”