Gallstone extraction and gallbladder removal
General Surgery Department, Xuanwu Hospital, Capital Medical University
Zheng Yamin
Cholecystectomy
In 1882, the first cholecystectomy was performed in Langenbuch, Germany.
Zheng Yamin, Department of General Surgery, Xuanwu Hospital, Capital Medical University
Langenbuch proposed the principle of gallbladder stone treatment.
The method of removing stones by incision and preserving the gallbladder was incomplete and prone to recurrence (50%-80% at that time), the gallbladder should be removed, and now LC has become the gold standard of treatment
In 1988, Kelltt, Germany, first carried out percutaneous cholecystoscopic lithotripsy for stone preservation (PCCS), but after the operation, there were many bile leaks and high recurrence rate, so this operation was abandoned
“Hotbed doctrine”.
Gallbladder stones should be removed, not only because it contains stones but also because it can grow stones
“Focal theory”.
Any gallbladder with stones is mostly accompanied by chronic cholecystitis, and even if the stones are removed, the inflammation of the gallbladder still exists. The lesions cannot be left behind and should be removed together
Removal of the gallbladder has no definite serious damage.
Mercer et al. concluded that cholelithiasis, cholecystectomy and colorectal cancer are not related
Mercer PM, Reid FD, Harrison M, et al. The
relationship between
cholecystectomy unoperated gallstone disease,and colerectal cancer.necropsy study. scand J
Gastroenterology,1995,30:1017-1020
1867 John stough
Bobb’s cholecystotomy for a 32-year-old woman,
saving the patient’s life
Lithogenic theories of gallbladder stones: metabolic, infectious, and parasitic theories
“Small’s triangle theory of metabolism: cholesterol in the bile of the gallbladder is supersaturated and crystallizes to form stones; cholesterol comes from the liver, not from the gallbladder mucosa
Ran Ritu: Stone-forming bile comes from the liver; where there is bile, there is a possibility of stone formation, so there are intrahepatic stones, common bile duct stones and gallbladder stones
Domestic research on bile preservation and lithotripsy
A meta-analysis of the literature on new biliary stone extraction in 4 major domestic journal databases.
15 articles in the literature, 1733 cases, 1546 cases followed up, 1436 cases >1 year
There were few complications, 8 cases of incisional effusion and 2 cases of infection,
4 cases of peritoneal effusion, 1 case of bile leak.
Recurrence 20 cases (1.29%)
Gu Hao, Cao Jun, Zhao Jinming, Zhang Jinhui. A meta-analysis of domestic biliary stone retrieval. Chinese Journal of Modern Medicine.
2008, 18(22): 3355-3357
2011 The Third Conference on Endoscopic Gallstone Retrieval by Chinese Physicians Association.
Reported 6750 cases of cholecystectomy and 3699 cases of endoscopic minimally invasive biliary stone retrieval
Recurrence rate after biliary stone extraction 4%-9.76%, mostly 6-36 months after surgery
How to recognize and deal with
Scientific attitude
Fully understand that the purpose of both biliary preservation and cholecystectomy is to treat patients’ diseases and maintain health
Objective awareness: the imbalance between the degree of knowledge of the disease, the goals of patient needs and the current technical conditions of treatment
Rigorous clinical practice
Strict indications and protocols for biliary preservation surgery Close observation of clinical outcomes Obtaining evidence-based medical evidence
Let the facts speak for themselves and deepen understanding in research
Standardized indications for biliary surgery
Strict operational specifications
Our hospital conducts research on combined laparoscopic choledochoscopic biliary stone extraction surgery