Laparoscopic cholecystectomy versus transvaginal natural orifice transluminal endoscopic surgery cholecystectomy: results of a prospective comparative single-center study

Gastrointest Endosc. 2018 Feb;87(2):509-516. doi: 10.1016/j.gie.2017.09.039. Epub 2017 Oct 6.

Abstract

Background and aims: Laparoscopic cholecystectomy (LC) in female individuals has been challenged recently by transvaginal natural orifice transluminal endoscopic surgery cholecystectomy (TVC). TVC has not been widely accepted as a standard procedure, even though it is reported to be a safe and painless alternative to LC. This prospective comparative study aims to not only prove equality of TVC and LC but to underline the advantages of TVC over LC with regard to postoperative pain.

Methods: This study presents an analysis of a single-center and single-surgeon study with 226 unselected consecutive cholecystectomies performed as either TVC or LC.

Results: A total of 226 female patients underwent surgery with either LC (136 cases) or TVC (90 cases). There were no postoperative adverse events. Twenty-two patients (24.2%) in the TVC group indicated 0 (no pain) on a visual analog scale postoperatively, whereas only 5 patients (3.7%) did so in the LC group (P = < .0001). Overall consumption of non-steroidal anti-inflammatory drugs was significantly less (P < .0001; t test) in the TVC group (mean, 1.2 ± 0.11 g) compared with the LC group (mean, 2.1 ± 0.1 g). Twenty-three patients (25.5%) in the TVC group needed no postoperative analgesics at all.

Conclusions: TVC is a safe and painless procedure for patients with symptomatic cholelithiasis who are from various ethnic and cultural origins. This benefit, along with an equal safety profile compared with LC, should pave the way for wider application of TVC in women.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Cholecystectomy / adverse effects*
  • Cholecystectomy / methods*
  • Cholecystectomy, Laparoscopic / adverse effects
  • Cholelithiasis / surgery
  • Female
  • Humans
  • Length of Stay
  • Middle Aged
  • Natural Orifice Endoscopic Surgery / adverse effects*
  • Pain Measurement
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / etiology*
  • Prospective Studies
  • Vagina

Substances

  • Anti-Inflammatory Agents, Non-Steroidal