Beckers Perletti Louise, Pauwels Brecht, Verbert Ans, Sablon Thibault
General surgery, University hospital of Ghent, Ghent, Belgium.
Department of Gastroenterology, VITAZ hospital, Sint-Niklaas, Belgium.
Acta Chir Belg. 2025 Jul 23:1-10. doi: 10.1080/00015458.2025.2539096.
Laparoscopic cholecystectomy (LCCE) has been the standard treatment for acute cholecystitis since the 1980s, but it may pose a significant hazard for high-risk patients. Endoscopic gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) offers a minimally invasive alternative for these patients. While LAMS is effective, the need for subsequent LCCE and long-term outcomes remains under investigation. This study aims to retrospectively assess the safety and feasibility of cholecystectomy after LAMS placement in a series of patients initially deemed unfit for surgery.
A retrospective review included patients who underwent LCCE following EUS-GBD with LAMS between January and September 2024 was conducted. Data on demographics, procedural details, technical success, and postoperative outcomes were retrieved.
Eight patients with acute cholecystitis underwent gallbladder drainage with transduodenal LAMS placement. Two required ICU care for sepsis but recovered. All eight subsequently underwent elective LCCE with 100% technical success. LAMS placement facilitated faster resolution of cholecystitis, resulting in a clear visualization of Calot's triangle, allowing precise dissection and closure of the cholecystoduodenostomy without complications. The median interval between LAMS placement and LCCE was 117.5 days (111 days excluding one outlier). LCCE was performed in a median operative time of 49 minutes. No conversions to open surgery or postoperative complications occurred, and the median postoperative hospitalization was 2 days.
Interval LCCE following EUS-GBD is a safe and effective option for managing acute cholecystitis in high-risk patients, with outcomes comparable to standard LCCE. Randomized controlled trials are necessary to establish definitive guidelines for this approach.
自20世纪80年代以来，腹腔镜胆囊切除术（LCCE）一直是急性胆囊炎的标准治疗方法，但对于高危患者可能构成重大风险。使用管腔对合金属支架（LAMS）的内镜下胆囊引流术（EUS-GBD）为这些患者提供了一种微创替代方案。虽然LAMS有效，但后续LCCE的必要性和长期疗效仍在研究中。本研究旨在回顾性评估在一系列最初被认为不适合手术的患者中，LAMS置入后行胆囊切除术的安全性和可行性。
对2024年1月至9月期间接受EUS-GBD联合LAMS治疗后行LCCE的患者进行回顾性分析。收集患者的人口统计学资料、手术细节、技术成功率和术后结果。
8例急性胆囊炎患者接受了经十二指肠LAMS置入胆囊引流术。2例因脓毒症需要重症监护病房治疗，但已康复。所有8例患者随后均接受了择期LCCE，技术成功率达100%。LAMS置入有助于更快地缓解胆囊炎，使胆囊三角清晰可见，从而能够精确解剖并闭合胆囊十二指肠造口术，且无并发症发生。LAMS置入与LCCE之间的中位间隔时间为117.5天（排除1例异常值后为111天）。LCCE的中位手术时间为49分钟。未发生转为开放手术或术后并发症，术后中位住院时间为2天。
EUS-GBD术后间隔期行LCCE是治疗高危患者急性胆囊炎的一种安全有效的选择，其结果与标准LCCE相当。需要进行随机对照试验以确立该方法的明确指南。
