# Gallbladder-preserving cholelithotomy in selected patients with symptomatic cholelithiasis: A case series

## TL;DR

This paper presents a case series on a surgical technique that removes gallstones while preserving the gallbladder in patients who refuse gallbladder removal.

## Contribution

The study introduces a gallbladder-preserving cholelithotomy technique and evaluates its safety and efficacy in selected patients.

## Key findings

- GPC successfully removed gallstones in 52 out of 55 patients with no perioperative complications.
- Gallbladder ejection fractions improved postoperatively and there was no stone recurrence during follow-up.
- Three patients were converted to laparoscopic cholecystectomy due to specific anatomical issues.

## Abstract

Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of symptomatic cholelithiasis, but is associated with post cholecystectomy problems in some patients. However, some patients refuse cholecystectomy against organ loss. In suitable patients we employed gallbladder preserving cholelithotomy (GPC) with mini-incision to rid of their stones. Our aim is to introduce our technique of GPC and investigate its safety and efficacy.

Fifty-five biliary colic patients with a strong desire to retain their gallbladders harboring ≤3 gallstones with diameters <3 cm, wall thickness ≤3 mm, and gallbladder ejection fractions >50 % underwent GPC. Assessment of the gallbladder features by ultrasonography every 3 months in the first postoperative year and annually thereafter. We conducted the gastrointestinal quality of life index (GIQLI) survey in the 6th postoperative month.

Fifty-two patients had their gallstones successfully removed. We did not encounter any perioperative complication. We converted to laparoscopic cholecystectomy in three patients, one with multiple polyps and two with inflamed mucosa. Gallbladder ejection fractions in the 3rd postoperative month were statistically better than the preoperative period. The patients with preoperative symptoms were symptom free. The median follow-up time was 3 years. There was no stone recurrence.

GPC is a simple, safe and acceptable procedure. It may be employed in suitable symptomatic patients.

•Gallbladder preserving cholelithotomy may be an alternative option in selected patients with cholelithiasis who do not want their gallbladders removed.•A functional gallbladder is essential in gallbladder preserving cholelithotomy to minimize stone recurrence.•Stone recurrence and other complications are rare if only suitable patients are selected for cholelithotomy

Gallbladder preserving cholelithotomy may be an alternative option in selected patients with cholelithiasis who do not want their gallbladders removed.

A functional gallbladder is essential in gallbladder preserving cholelithotomy to minimize stone recurrence.

Stone recurrence and other complications are rare if only suitable patients are selected for cholelithotomy