Skip to main content

Advertisement

SpringerLink
Log in

Novel advances in surgery for Gallstone Disease

  • Endoscopy and Surgery (S Komanduri, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of review

Examine recent advances in the treatment of patients with complex gallstone disease.

Recent findings

Laparoscopic common bile duct exploration (LCBDE) has been shown to be an effective and safe treatment for choledocholithiasis, resulting in decreased hospital length of stay and costs when compared with ERCP plus laparoscopic cholecystectomy (LC). Novel simulator-based curricula have recently been developed to address the educational gap that has resulted in an underutilization of LCBDE. Patients with cholecystitis who are too ill to safely undergo LC have traditionally been treated with percutaneous cholecystostomy (PC). Endoscopic ultrasound (EUS) guided gallbladder drainage is a novel definitive treatment for such patients and has been shown to result in decreased complications and hospital readmissions compared to PC. The management of symptomatic gallstone disease during pregnancy has evolved over the last several decades. While it is now well established that laparoscopic procedures under general anesthesia are safe throughout a pregnancy, recent studies have suggested that laparoscopic cholecystectomy during the third trimester specifically may result in higher rates of preterm labor when compared with non-operative management. Finally, indocyanine green (ICG) fluorescence cholangiography is a novel imaging modality that has been used during laparoscopic cholecystectomy and may offer better visualization of biliary anatomy during dissection when compared with traditional intraoperative cholangiography.

Summary

A number of recent technological, procedural, educational, and research innovations have enhanced and expanded treatment options for patients with complex gallstone disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. National Center for Health Statistics. National Hospital Discharge Surgery. 2010. at http://www.cdc.gov/nchs/nhds.htm.).

  2. Houdart R, Perniceni T, Darne B, Salmeron M, Simon JF. Predicting common bile duct lithiasis: determination and prospective validation of a model predicting low risk. Am J Surg. 1995;170:38–43.

    Article  CAS  Google Scholar 

  3. Tranter SE, Thompson MH. Spontaneous passage of bile duct stones: frequency of occurrence and relation to clinical presentation. Ann R Coll Surg Engl. 2003;85:174–7.

    Article  CAS  Google Scholar 

  4. Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg. 2004;239:28–33.

    Article  Google Scholar 

  5. Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, Diamond T, Taylor MA. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 2013:CD003327.

  6. Navaratne L, Martinez Isla A. Transductal versus transcystic laparoscopic common bile duct exploration: an institutional review of over four hundred cases. Surg Endosc. 2021;35:437–48.

    Article  Google Scholar 

  7. Singh AN, Kilambi R. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis. Surg Endosc. 2018;32:3763–76.

    Article  Google Scholar 

  8. Wandling MW, Hungness ES, Pavey ES, Stulberg JJ, Schwab B, Yang AD, Shapiro MB, Bilimoria KY, Ko CY, Nathens AB. Nationwide Assessment of Trends in Choledocholithiasis Management in the United States From 1998 to 2013. JAMA Surg. 2016;151:1125–30.

    Article  Google Scholar 

  9. Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, Faggioni A, Ribeiro VM, Jakimowicz J, Visa J, Hanna GB. E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc. 1999;13:952–7.

    Article  CAS  Google Scholar 

  10. Helling TS, Khandelwal A. The challenges of resident training in complex hepatic, pancreatic, and biliary procedures. J Gastrointest Surg. 2008;12:153–8.

    Article  Google Scholar 

  11. Santos BF, Reif TJ, Soper NJ, Nagle AP, Rooney DM, Hungness ES. Development and evaluation of a laparoscopic common bile duct exploration simulator and procedural rating scale. Surg Endosc. 2012;26:2403–15.

    Article  Google Scholar 

  12. Teitelbaum EN, Soper NJ, Santos BF, Rooney DM, Patel P, Nagle AP, Hungness ES. A simulator-based resident curriculum for laparoscopic common bile duct exploration. Surgery. 2014;156:880–7. 90 – 3.

    Article  Google Scholar 

  13. Schwab B, Teitelbaum EN, Barsuk JH, Soper NJ, Hungness ES. Single-stage laparoscopic management of choledocholithiasis: An analysis after implementation of a mastery learning resident curriculum. Surgery. 2018;163:503–8.

    Article  Google Scholar 

  14. Campagna RAJ, Belette AM, Holmstrom AL, Halverson AL, Santos BF, Hungness ES, Teitelbaum EN. Addressing the gap in laparoscopic common bile duct exploration training for rural surgeons: imparting procedural ability is not enough. Surg Endosc. 2021;35:5140–6.

    Article  Google Scholar 

  15. Brewer JO, Navaratne L, Marchington SW, Martinez Cecilia D, Quinones Sampedro J, Munoz Bellvis L, Isla AM. Porcine Aorto-Renal Artery (PARA) model for laparoscopic transcystic common bile duct exploration: the evolution of a training model to meet new clinical needs. Langenbecks Arch Surg. 2021;406:1149–54.

    Article  Google Scholar 

  16. Navarro-Sanchez A, Ashrafian H, Segura-Sampedro JJ, Martrinez-Isla A. LABEL procedure: Laser-Assisted Bile duct Exploration by Laparoendoscopy for choledocholithiasis: improving surgical outcomes and reducing technical failure. Surg Endosc. 2017;31:2103–8.

    Article  Google Scholar 

  17. Huang SZ, Chen HQ, Liao WX, Zhou WY, Chen JH, Li WC, Zhou H, Liu B, Hu KP. Comparison of emergency cholecystectomy and delayed cholecystectomy after percutaneous transhepatic gallbladder drainage in patients with acute cholecystitis: a systematic review and meta-analysis. Updates Surg. 2021;73:481–94.

    Article  Google Scholar 

  18. Dimou FM, Adhikari D, Mehta HB, Riall TS. Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis. J Am Coll Surg 2017;224:502–11 e1.

    Article  Google Scholar 

  19. Teoh AYB, Kitano M, Itoi T, Perez-Miranda M, Ogura T, Chan SM, Serna-Higuera C, Omoto S, Torres-Yuste R, Tsuichiya T, Wong KT, Leung CH, Chiu PWY, Ng EKW, Lau JYW. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1). Gut. 2020;69:1085–91.

    Article  CAS  Google Scholar 

  20. Roulin D, Saadi A, Di Mare L, Demartines N, Halkic N. Early Versus Delayed Cholecystectomy for Acute Cholecystitis, Are the 72 hours Still the Rule?: A Randomized Trial. Ann Surg. 2016;264:717–22.

    Article  Google Scholar 

  21. Luk SW, Irani S, Krishnamoorthi R, Wong Lau JY, Wai Ng EK, Teoh AY. Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis. Endoscopy. 2019;51:722–32.

    Article  Google Scholar 

  22. Stirrat J, Patel NR, Stella SF, Mafeld S, Ho CS, Shlomovitz E. Safety and Efficacy of Percutaneous Gallstone Extraction in High-Risk Patients: An Alternative to Cholecystectomy or Long-Term Drainage? J Am Coll Surg. 2021;232:195–201.

    Article  Google Scholar 

  23. Jorge AM, Keswani RN, Veerappan A, Soper NJ, Gawron AJ. Non-operative management of symptomatic cholelithiasis in pregnancy is associated with frequent hospitalizations. J Gastrointest Surg. 2015;19:598–603.

    Article  Google Scholar 

  24. ACOG Committee Opinion No. 775: Nonobstetric Surgery During Pregnancy. Obstet Gynecol. 2019;133:e285-e6.

    Google Scholar 

  25. Veerappan A, Gawron AJ, Soper NJ, Keswani RN. Delaying cholecystectomy for complicated gallstone disease in pregnancy is associated with recurrent postpartum symptoms. J Gastrointest Surg. 2013;17:1953–9.

    Article  Google Scholar 

  26. Ibiebele I, Schnitzler M, Nippita T, Ford JB. Outcomes of Gallstone Disease during Pregnancy: a Population-based Data Linkage Study. Paediatr Perinat Epidemiol. 2017;31:522–30.

    Article  Google Scholar 

  27. Cheng V, Matsushima K, Sandhu K, Ashbrook M, Matsuo K, Inaba K, Demetriades D. Surgical trends in the management of acute cholecystitis during pregnancy. Surg Endosc. 2021;35:5752–9.

    Article  Google Scholar 

  28. Fong ZV, Pitt HA, Strasberg SM, Molina RL, Perez NP, Kelleher CM, Loehrer AP, Sicklick JK, Talamini MA, Lillemoe KD, Chang DC. California Cholecystectomy G. Cholecystectomy During the Third Trimester of Pregnancy: Proceed or Delay? J Am Coll Surg 2019;228:494–502 e1.

    Article  Google Scholar 

  29. Hong J, Yang J, Zhang X, Su J, Tumati A, Garry D, Docimo S, Bates AT, Spaniolas K, Talamini MA, Pryor AD. Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc. 2021;35:4673–80.

    Article  Google Scholar 

  30. Pearl JP, Price RR, Tonkin AE, Richardson WS, Stefanidis D. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc. 2017;31:3767–82.

    Article  Google Scholar 

  31. Berci G, Hunter J, Morgenstern L, Arregui M, Brunt M, Carroll B, Edye M, Fermelia D, Ferzli G, Greene F, Petelin J, Phillips E, Ponsky J, Sax H, Schwaitzberg S, Soper N, Swanstrom L, Traverso W. Laparoscopic cholecystectomy: first, do no harm; second, take care of bile duct stones. Surg Endosc. 2013;27:1051–4.

    Article  Google Scholar 

  32. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010;211:132–8.

    Article  Google Scholar 

  33. Lim SH, Tan HTA, Shelat VG. Comparison of indocyanine green dye fluorescent cholangiography with intra-operative cholangiography in laparoscopic cholecystectomy: a meta-analysis. Surg Endosc. 2021;35:1511–20.

    Article  Google Scholar 

  34. Dip F, Lo Menzo E, White KP, Rosenthal RJ. Does near-infrared fluorescent cholangiography with indocyanine green reduce bile duct injuries and conversions to open surgery during laparoscopic or robotic cholecystectomy? - A meta-analysis. Surgery. 2021;169:859–67.

    Article  Google Scholar 

  35. Boogerd LSF, Handgraaf HJM, Huurman VAL, Lam HD, Mieog JSD, van der Made WJ, van de Velde CJH, Vahrmeijer AL. The Best Approach for Laparoscopic Fluorescence Cholangiography: Overview of the Literature and Optimization of Dose and Dosing Time. Surg Innov. 2017;24:386–96.

    Article  Google Scholar 

  36. Dip F, LoMenzo E, Sarotto L, Phillips E, Todeschini H, Nahmod M, Alle L, Schneider S, Kaja L, Boni L, Ferraina P, Carus T, Kokudo N, Ishizawa T, Walsh M, Simpfendorfer C, Mayank R, White K, Rosenthal RJ. Randomized Trial of Near-infrared Incisionless Fluorescent Cholangiography. Ann Surg. 2019;270:992–9.

    Article  Google Scholar 

Download references

Funding

Dr. Bass has nothing to disclose. Dr. Teitelbaum reports personal fees from Boston Scientific, outside the submitted work.

Author information

Authors and Affiliations

  1. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Rachel B. Bass

  2. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Ezra N. Teitelbaum

  3. Department of Surgery, 676 St Clair St., Suite 650, 60611, Chicago, IL, USA

    Ezra N. Teitelbaum

Authors
  1. Rachel B. Bass
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ezra N. Teitelbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ezra N. Teitelbaum.

Ethics declarations

Funding and/or Conflicts of interests/Competing interests

Dr. Bass has nothing to disclose. Dr. Teitelbaum reports personal fees from Boston Scientific, outside the submitted work.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection Endoscopy and Surgery.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bass, R.B., Teitelbaum, E.N. Novel advances in surgery for Gallstone Disease. Curr Gastroenterol Rep 24, 89–98 (2022). https://doi.org/10.1007/s11894-022-00844-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-022-00844-7

Keywords

Search

Navigation