Gallstone disease is one of the most common surgical conditions, which includes gallbladder stones, common bile duct stones and intrahepatic bile duct stones. Among them, gallbladder stones are the most common type of gallstone disease, mainly cholesterol stones or cholesterol-based mixed stones, commonly found in adults, women, over 40 years old, obese and with family history.
They are common in adults, women, over 40 years of age, obese, and with a family history. The prevalence in the natural population is as high as 10%. However, about 20-40% of patients with gallbladder stones
The rest have clinical symptoms, including dyspepsia, biliary colic, fever, vomiting and other discomforts, which are mainly related to the size and location of the stone, as well as the combination of biliary tract infection, obstruction and gallbladder function. The main concerns of patients regarding the treatment of gallbladder stones are as follows: 1. Should we operate on asymptomatic gallbladder stones (static gallbladder stones)? There is no need to rush surgery for static gallbladder stones, especially for patients with high risk factors for surgery, and follow-up is currently advocated. However, surgery should be considered if the following conditions are combined: (1) cholecystography shows non-functional or non-visible gallbladder; (2) ultrasound indicates porcelain gallbladder; (3) stone diameter is more than 2-3 cm, and the chance of gallbladder cancer is significantly higher; (4) ideal glycemic control in patients with combined diabetes. 2.Does gallbladder stone surgery require gallbladder preservation? At present, cholecystectomy is the preferred method for the treatment of gallbladder stones. Although some scholars have explored biliary preservation and stone extraction, there are still problems such as inaccurate efficacy after surgery and elimination of stone recurrence. Due to the short follow-up years and the lack of data from large-scale randomized controlled clinical studies, the application value of cholecystectomy needs further verification. 3. Is cholecystectomy open or minimally invasive? LC has become the international “gold standard” procedure for the treatment of benign gallbladder disease, with the advantages of less trauma and faster recovery. However, LC cannot be performed in the following cases: extensive and severe intra-abdominal adhesions, combined bile-intestinal fistula, Mirizzi
syndrome, and unclear anatomy of the gallbladder triangle. In some special cases, there is a possibility that LC may be performed as an intermediate open procedure, and it is important not to cause serious complications for the sake of minimally invasive surgery, resulting in minimally invasive surgery becoming massively invasive. Therefore, open cholecystectomy is the backup guarantee for LC. 4.The choice of minimally invasive surgery? Laparoscopic surgery includes four-hole, three-hole, two-hole, single-hole surgery, and even endoscopic surgery via natural orifice transluminal (NOTES).
endoscopic
(natural orifice transluminal endoscopic surgery) method. The choice of the specific procedure is mainly related to the patient’s disease condition, the hospital’s equipment, the personal skills of the operator, people’s ideology and social progress. Of course, the NOTES method is the least traumatic, but there is still a long way to go for its wide application in clinical practice, and it is still only at the stage of preclinical animal studies. It is hoped that in the near future, with the advancement of technology and continuous updating of equipment, a safe, minimally invasive, scarless and close to conventional lumpectomy technique will emerge as a bridge and technical preparation for the transition from conventional lumpectomy to NOTES.
The bridge and technology preparation for the transition to NOTES will eventually enable NOTES to be widely used for the benefit of patients.