Gallbladder-preserving polypectomy for gallbladder polyp by embryonic-natural orifice transumbilical endoscopic surgery with a gastric endoscopy

Abstract

Background and aims Cholecystectomy is performed for most gallbladder polyps (GPs). However, cholecystectomy results concerning complications in some patients. For benign GPs, adoption of gallbladder-preserving surgery is worth to recommend. We describe our experiences performing gallbladder-preserving polypectomy for GPs by embryonic-natural orifice transumbilical endoscopic surgery (E-NOTES) with a gastric endoscopy. Methods This is a retrospective study of patients with GPs who underwent gallbladder-preserving polypectomy by E-NOTES with a gastric endoscopy from April 2018 to September 2019 in our hospital. The operative time, intraoperative hemorrhage, intraoperative and postoperative complications, gallbladder emptying function were obtained and analyzed. Results The procedure was performed successfully in all 12 patients with 5 cases of single polyp and 7 cases of multiple polyps. The range of GPs size was 2 mm to 15 mm. The mean operation time was (95.33 ± 23.08) minutes (55–135 min). There were no adverse events including heavy bleeding, mortality and conversion to open surgery during operation. All patients were discharged in 4–5 days after surgery without postoperative complications such as delayed bleeding, fever, peritonitis, intra-abdominal abscess and abdominal wall incisional hernia. All patients were followed up at 1, 3, 6, and 12 months postoperation who had almost no visible incision on the umbilical region, no recurrent GPs. The gallbladder emptying function decreased one month after surgery, and gradually improved 3, 6 and 12 months after surgery. Conclusion E-NOTES gallbladder-preserving polypectomy is a safe and effective option for patients with GPs and is close to scar-free surgery which can be performed in routine clinical practice.

Advances in the management of gallbladder polyps: establishment of predictive models and the rise of gallbladder-preserving polypectomy procedures

“…To assess the treatment effect of gallbladder-preserving therapy, the methods of testing the gallbladder function have to be mentioned. Currently, gallbladder-emptying function is assessed clinically by comparing the variation of cholecyst volume between fasting and high-fat diet with the help of ultrasound [ 27 , 38 , 41 ]. This approach approximately treats the irregularly shaped gallbladder as a regular ellipsoid [ 48 ].…”

“…Moreover, they should evaluate the feasibility of gallbladder preservation according to what they see intraoperatively. It has been demonstrated that gallbladder emptying functions return to preoperative levels 1 year after surgery and devices to close the gallbladder wound (such as hemostatic clips) do not provoke discomforts in patients or affect gallbladder functions [ 38 ].…”

“…E-NOTEGPP is a surgical approach in which the gastroscope enters the abdominal cavity through a periumbilical incision, locates and dissects the gallbladder, and then it enters the gallbladder cavity to manage the polypoid lesions. He et al found no obvious scar or recurrence in 12 patients with GBPs after surgery and 1-year follow-up, while gallbladder emptying functions were largely restored to preoperative levels [ 38 ].…”

“…Compared to NOTEGPP, this procedure opens access to the abdominal cavity from the body surface and is an almost scarless surgical method. Compared to Endolap polypectomy, E-NOTEGPP has the following advantages [ 38 ]: (i) The umbilical cord is the weakest part of the abdominal wall, and transumbilical puncture can reduce abdominal wall injury and relieve the pain from the surgical wound. (ii) The 2–4 incisions in the abdomen of the Endolap polypectomy can be transformed into a small incision of 10 mm in the umbilical cord.…”

Update on the natural orifice transluminal endoscopic surgery for gallbladder preserving gallstones therapy: A review

“…Experimental studies on pure NOTES have proposed procedures as attractive alternative options for intra-abdominal procedures. [18][19][20] However, some technical obstacles remained including the risk of fecal contamination and peritoneal infection, availability of methods for safe entrance into the peritoneal cavity as well as for reliable entry site closure. [21,22] A recent study confirmed the efficacy of using a detachable endo-colonic balloon to keep the distal colonic and rectal lumen clean and aseptic during transrectal NOTES endoscopic procedures.…”