A clinical study of endoscopic naso-gallbladder drainage-assisted laparoscopic subtotal cholecystectomy

Objective To summarize our experience in endoscopic naso-gallbladder drainage ( ENGBD) -assisted laparoscopic subtotal cholecystectomy ( LSC) in patients with chronic atrophic cholecystitis. Methods A retrospective analysis was performed for the clinical data of 124 patients with chronic atrophic cholecystitis complicated by secondary common bile duct stones who were admitted to Department of Hepatobiliary Surgery in Chongqing Hospital of Armed Police Force, Department of General Surgery in The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, and Department of General Surgery in Chongqing Traditional Chinese Medicine Hospital from January 2007 to December 2016. All patients underwent endoscopic retrograde cholangiopancreatography ( ERCP) , sphincterotomy, and lithotomy. The patients undergoing ENGBD were enrolled as experimental group ( group A with 47 patients) , and those undergoing endoscopic nasobiliary drainage ( ENBD) were enrolled as control group ( group B with 77 patients) . All patients were treated with laparoscopic cholecystectomy ( LC) or LSC after ERCP, and the patients in difficult conditions were converted to open cholecystectomy ( OC) . The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results Compared with group B, group A had a significantly higher success rate of LSC ( 53. 2% vs 20. 8%) and a significantly lower proportion of patients undergoing OC ( 4. 3% vs 35. 1%) . Due to the complicated conditions such as internal fistula between the gallbladder and adjacent organs ( including Mirizzi syndrome) , unsuspected gallbladder carcinoma, and cystic duct abnormalities, group B had a great difficulty in the placement of ENGBD, which led to injuries in the hepatic artery/vein, and some patients were converted to open surgery due to concerns of bile duct injury. Conclusion In patients with chronic atrophic cholecystitis with secondary choledocholithiasis, ENGBD after ERCP helps with the successful performance of LSC and can effectively reduce the proportion of conversion to laparotomy.