Biliary Preservation Surgery vs. Cholecystectomy: A Re-Evaluation of the Era of Precision Medicine
DOI:
https://doi.org/10.71222/bvemky33Keywords:
gallbladder-preserving surgery, cholecystectomy, precision medicine, personalized treatment, surgical assessmentAbstract
In the management of biliary diseases, gallbladder-preserving surgery and cholecystectomy are two primary surgical strategies that have attracted considerable attention. With the advent of precision medicine, the development of advanced diagnostic tools and personalized treatment approaches necessitates a re-evaluation of their clinical applications. Gallbladder-preserving surgery, including procedures such as partial cholecystectomy and gallbladder-preserving lithotomy, aims to remove pathological lesions while retaining as much functional gallbladder tissue as possible, whereas cholecystectomy involves complete removal of the diseased gallbladder to prevent recurrence. Each approach has distinct advantages and limitations: gallbladder-preserving surgery maintains gallbladder function and supports normal biliary physiology, while cholecystectomy provides definitive resolution of gallbladder pathology with a lower recurrence risk. However, gallbladder-preserving procedures carry the potential for disease recurrence, and cholecystectomy may result in loss of gallbladder function and associated complications. Recent studies have explored the indications, surgical outcomes, and long-term prognosis of these procedures across diverse patient populations. Guided by precision medicine, the integration of genetic testing, advanced imaging modalities, and biomarker assessments enables more accurate risk stratification and individualized treatment planning, enhancing both surgical safety and efficacy. This article systematically reviews recent literature on gallbladder-preserving surgery and cholecystectomy, providing a comprehensive evaluation of indications, therapeutic effects, complications, and postoperative recovery, with the aim of offering clinicians evidence-based guidance for selecting the most appropriate surgical approach for each patient.
References
1. D. R. Urbach, and T. A. Stukel, "Rate of elective cholecystectomy and the incidence of severe gallstone disease," Cmaj, vol. 172, no. 8, pp. 1015-1019, 2005.
2. J. Liu, X. Zhu, Q. Zhao, K. Huang, D. Zhou, X. Zhang, and J. Gu, "A new operation for gallstones: choledochoscopic gallbladder-preserving cholecystolithotomy, a retrospective study of 3,511 cases," Surgery, vol. 172, no. 5, pp. 1302-1308, 2022. doi: 10.1016/j.surg.2022.08.008
3. Z. Y. Jia, Y. D. Zhu, X. S. Wu, J. X. Yang, W. G. Wu, X. A. Wang, and Y. B. Liu, "Improved longterm outcomes after innovative preoperative evaluation and conception of precise surgery for gallbladder cancer," Cancer Medicine, vol. 12, no. 18, pp. 18861-18871, 2023.
4. A. K. Agarwal, A. Javed, R. Kalayarasan, and P. Sakhuja, "Minimally invasive versus the conventional open surgical approach of a radical cholecystectomy for gallbladder cancer: a retrospective comparative study," HPB, vol. 17, no. 6, pp. 536-541, 2015. doi: 10.1111/hpb.12406
5. Y. Hao, Z. Yang, H. Yang, and J. Hong, "Gallbladder-preserving cholecystolithotomy," Expert Review of Gastroenterology & Hepatology, vol. 16, no. 3, pp. 265-272, 2022. doi: 10.1080/17474124.2022.2047650
6. M. A. Rabie, and A. Sokker, "Cholecystolithotomy, a new approach to reduce recurrent gallstone ileus," Acute medicine & surgery, vol. 6, no. 2, pp. 95-100, 2019. doi: 10.1002/ams2.404
7. M. DANIEL, "10 Beyond Bao," Writing and Law in Late Imperial China: Crime, Conflict, and Judgment, vol. 215, 2015.
8. P. Chowbey, A. Sharma, A. Goswami, Y. Afaque, K. Najma, M. Baijal, and R. Khullar, "Residual gallbladder stones after cholecystectomy: a literature review," Journal of Minimal Access Surgery, vol. 11, no. 4, pp. 223-230, 2015.
9. J. F. Du, G. L. Yang, Z. M. Dai, X. C. Cai, H. Y. Zhong, L. Liu, and L. Xu, "Transcystic Duct Gallbladder-preserving Cholecystolithotomy by ERCP: Efficacy in Managing Cholecystolithiasis With or Without Common Bile Duct Stones," Surgical Laparoscopy Endoscopy & Percutaneous Techniques, pp. 10-1097, 2025.
10. Y. Y. Tan, G. Zhao, D. Wang, J. M. Wang, J. R. Tang, and Z. L. Ji, "A new strategy of minimally invasive surgery for cholecystolithiasis: calculi removal and gallbladder preservation," Digestive surgery, vol. 30, no. 4-6, pp. 466-471, 2014.
11. W. YOU, Y. LIANG, and L. LYU, "Pathogenesis and clinical translation of intrahepatic cholangiocarcinoma in the era of precision medicine," Journal of Clinical Hepatology, pp. 935-938, 2021.
12. H. Liu, Y. Lu, K. Shen, M. Zhou, X. Mao, and R. Li, "Advances in the management of gallbladder polyps: establishment of predictive models and the rise of gallbladder-preserving polypectomy procedures," BMC gastroenterology, vol. 24, no. 1, p. 7, 2024. doi: 10.1186/s12876-023-03094-7
13. K. Okumura, S. Gogna, M. Gachabayov, D. M. Felsenreich, M. McGuirk, A. Rojas, and X. Da Dong, "Gallbladder cancer: Historical treatment and new management options," World Journal of Gastrointestinal Oncology, vol. 13, no. 10, p. 1317, 2021.
14. F. Liu, Z. R. Wu, H. J. Hu, Y. W. Jin, W. J. Ma, J. K. Wang, and F. Y. Li, "Current status and future perspectives of minimally invasive surgery in gallbladder carcinoma," ANZ journal of surgery, vol. 91, no. 3, pp. 264-268, 2021.
15. T. Qiao, R. H. Ma, X. B. Luo, L. Q. Yang, Z. L. Luo, and P. M. Zheng, "The systematic classification of gallbladder stones," Plos one, vol. 8, no. 10, p. e74887, 2013.
16. S. Ullah, B. H. Yang, D. Liu, X. Y. Lu, Z. Z. Liu, L. X. Zhao, and B. R. Liu, "Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable? A propensity matched study," World Journal of Gastrointestinal Surgery, vol. 14, no. 5, p. 470, 2022.
17. P. Liu, Y. W. Chen, C. Liu, Y. T. Wu, W. C. Zhao, J. Y. Zhu, and N. X. Xia, "Development and validation of a nomogram model for predicting the risk of gallstone recurrence after gallbladder-preserving surgery," Hepatobiliary & Pancreatic Diseases International, vol. 23, no. 3, pp. 288-292, 2024.
18. E. Nilsson, A. Ros, M. Rahmqvist, K. Bäckman, and P. Carlsson, "Cholecystectomy: costs and health-related quality of life: a comparison of two techniques," International journal for quality in health care, vol. 16, no. 6, pp. 473-482, 2004.
19. G. Cassese, H. S. Han, Y. S. Yoon, J. S. Lee, J. Y. Cho, H. W. Lee, and R. I. Troisi, "Preoperative assessment and perioperative management of resectable gallbladder cancer in the era of precision medicine and novel technologies: state of the art and future perspectives," Diagnostics, vol. 12, no. 7, p. 1630, 2022.
20. A. Edsjö, L. Holmquist, B. Geoerger, F. Nowak, G. Gomon, C. Alix‐Panabières, and A. Stenzinger, "Precision cancer medicine: Concepts, current practice, and future developments," Journal of internal medicine, vol. 294, no. 4, pp. 455-481, 2023. doi: 10.1111/joim.13709
21. T. Bates, M. Harrison, S. R. Ebbs, and R. P. A'hern, "Influence of cholecystectomy on symptoms," Journal of British Surgery, vol. 78, no. 8, pp. 964-967, 1991.
22. A. R. Ferreres, and H. J. Asbun, "Technical aspects of cholecystectomy," Surgical Clinics, vol. 94, no. 2, pp. 427-454, 2014. doi: 10.1016/j.suc.2014.01.007
23. J. Hedström, "Management of Gallstone Disease in Pregnancy," Aspects on Intervention, Outcome and Patient Experience, 2023.
24. N. Y. Cho, N. L. Chervu, S. Sakowitz, A. Verma, E. Kronen, M. Orellana, and P. Benharash, "Effect of surgical timing on outcomes after cholecystectomy for mild gallstone pancreatitis," Surgery, vol. 174, no. 3, pp. 660-665, 2023. doi: 10.1016/j.surg.2023.05.009
25. S. H. Loosen, A. Breuer, F. Tacke, J. N. Kather, J. Gorgulho, P. H. Alizai, and T. Luedde, "Circulating levels of soluble urokinase plasminogen activator receptor predict outcome after resection of biliary tract cancer," JHEP Reports, vol. 2, no. 2, p. 100080, 2020. doi: 10.1016/j.jhepr.2020.100080
26. O. Avrutis, S. J. Friedman, J. Meshoulm, L. Haskel, and S. Adler, "Safety and success of early laparoscopic cholecystectomy for acute cholecystitis," Surgical Laparoscopy Endoscopy & Percutaneous Techniques, vol. 10, no. 4, pp. 200-207, 2000. doi: 10.1097/00129689-200008000-00003
27. S. D. Hearing, L. A. Thomas, K. W. Heaton, and L. Hunt, "Effect of cholecystectomy on bowel function: a prospective, controlled study," Gut, vol. 45, no. 6, pp. 889-894, 1999. doi: 10.1136/gut.45.6.889
28. H. Vishnu Teja, "A Comparative Study Of Extra Corporeal Knotting Versus Clips For Ligating Cystic Duct In Laparoscopic Cholecystectomy (Doctoral dissertation, BLDE (Deemed to be University))," 2020.
29. B. M. Tracy, C. W. Paterson, D. M. Torres, K. Young, B. R. Hochman, M. D. Zielinski, and K. Venincasa, "Risk factors for complications after cholecystectomy for common bile duct stones: an EAST multicenter study," Surgery, vol. 168, no. 1, pp. 62-66, 2020. doi: 10.1016/j.surg.2020.04.011
30. H. Cao, E. F. Oghenemaro, A. Latypova, M. K. Abosaoda, G. S. Zaman, and A. Devi, "Advancing clinical biochemistry: addressing gaps and driving future innovations," Frontiers in Medicine, vol. 12, p. 1521126, 2025. doi: 10.3389/fmed.2025.1521126
31. Sun, R.-T., et al., “A radiomics-clinical predictive model for difficult laparoscopic cholecystectomy based on preoperative CT imaging: a retrospective single center study,” World Journal of Emergency Surgery, vol. 20, no. 1, p. 62, 2025.
32. J. J. Tu, Z. Chen, Z. Q. Zhou, and F. Y. Lu, "Postoperative care for patients undergoing cholecystectomy: A comprehensive nursing review," World Journal of Gastrointestinal Surgery, vol. 17, no. 8, p. 106170, 2025.
33. M. Kunkala, J. Bingener, M. Park, W. Scott Harmsen, A. McConico, and K. Reid Lombardo, "Single-port and four-port laparoscopic cholecystectomy: difference in outcomes," Minerva Chirurgica, vol. 68, no. 2, pp. 155-162, 2013.
34. P. Scherz, "The Ethics of Precision Medicine: The Problems of Prevention in Healthcare," University of Notre Dame Pess, 2024.
35. Q. Qu, W. Chen, X. Liu, W. Wang, T. Hong, W. Liu, and X. He, "Role of gallbladder-preserving surgery in the treatment of gallstone diseases in young and middle-aged patients in China: results of a 10-year prospective study," Surgery, vol. 167, no. 2, pp. 283-289, 2020. doi: 10.1016/j.surg.2019.09.001
36. R. L. Coleman, and U. A. Matulonis, "Precision medicine," Gynecologic oncology, vol. 141, no. 1, p. 1, 2016.
37. Y. D. Li, B. N. Liu, S. H. Zhao, Y. L. Zhou, L. Bai, and E. Q. Liu, "Changes in gut microbiota composition and diversity associated with post-cholecystectomy diarrhea," World Journal of Gastroenterology, vol. 27, no. 5, p. 391, 2021.
38. T. R. Brown, "The results of treatment-Medical and surgical-in gall bladder disease: From a clinician's viewpoint," The American Journal of Digestive Diseases, vol. 1, no. 3, pp. 221-227, 1934.
39. D. M. Korngiebel, K. E. Thummel, and W. Burke, "Implementing precision medicine: the ethical challenges," Trends in pharmacological sciences, vol. 38, no. 1, pp. 8-14, 2017. doi: 10.1016/j.tips.2016.11.007
40. K. Singh, and A. Ohri, "Anatomic landmarks: their usefulness in safe laparoscopic cholecystectomy," Surgical Endoscopy and Other Interventional Techniques, vol. 20, no. 11, pp. 1754-1758, 2006. doi: 10.1007/s00464-005-0528-4
41. A. Kareem, "Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of results between early and late cholecystectomy (Doctoral dissertation, Doctoral dissertation, College of Medicine Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of results between early and late cholecystectomy Submitted to the Council of the College of Medicine, Diyala University)," 2022.
42. G. S. Ginsburg, and K. A. Phillips, "Precision medicine: from science to value," Health affairs, vol. 37, no. 5, pp. 694-701, 2018. doi: 10.1377/hlthaff.2017.1624
43. C. Gustafsson, "Surgeon-performed ultrasound and timing of surgery in acute cholecystitis (Doctoral dissertation, Karolinska Institutet (Sweden))," 2020.
44. J. Qin, L. Y. Gou, W. Zhang, X. Pu, and P. Zhang, "Enhanced recovery after surgery versus conventional care in cholecystectomy: A systematic review and Meta-Analysis," Journal of Laparoendoscopic & Advanced Surgical Techniques, vol. 34, no. 8, pp. 710-720, 2024.
45. M. Toleska, A. Dimitrovski, M. Shosholcheva, A. Kartalov, B. Kuzmanovska, and N. T. Dimitrovska, "Pain and multimodal analgesia in laparoscopic cholecystectomy," prilozi, vol. 43, no. 2, pp. 41-9, 2022.
46. J. Chen, X. Q. Hu, Q. L. Chen, Y. Hu, and S. Su, "Precision Medical Treatment in Traditional Chinese Medicine," J Altern Complement Integr Med, vol. 3, p. 024, 2017.
47. F. Swahn, "Aspects of interventional endoscopic treatment of common bile duct stones," Karolinska Institutet (Sweden), 2012.
48. I. Vlastos, K. Gkouskou, M. Doulaptsi, A. Karatzanis, and E. P. Prokopakis, "Precision medicine in rhinosinusitis," Current Allergy and Asthma Reports, vol. 19, no. 2, p. 12, 2019. doi: 10.1007/s11882-019-0850-x
49. A. F. Almutairi, and Y. A. Hussain, "Triangle of safety technique: a new approach to laparoscopic cholecystectomy," HPB surgery, vol. 2009, no. 1, p. 476159, 2009.
50. X. Wang, "New strategies of clinical precision medicine," Clinical and translational medicine, vol. 12, no. 2, p. e135, 2022. doi: 10.1002/ctm2.135
51. A. F. A. Mentis, K. Pantelidi, E. Dardiotis, G. M. Hadjigeorgiou, and E. Petinaki, "Precision medicine and global health: the good, the bad, and the ugly," Frontiers in medicine, vol. 5, p. 67, 2018.
52. A. Pouliot-Laforte, E. Dubé, D. Kairy, and D. E. Levac, "Exploring the emerging concept of precision rehabilitation: a qualitative study," medRxiv, pp. 2025-07, 2025. doi: 10.1101/2025.07.03.25330802
53. L. M. Fleck, "Precision medicine and the fragmentation of solidarity (and justice)," Medicine, Health Care and Philosophy, vol. 25, no. 2, pp. 191-206, 2022. doi: 10.1007/s11019-022-10067-2
54. H. Yin, W. Chen, L. Dong, S. Zhou, Q. Qu, N. Zhang, and X. He, "Changes of Bile Acids and Energy Expenditure after Laparoscopic Cholecystectomy in type 2 Diabetes Patients: A Prospective Study," 2021.
55. M. Vannucci, G. G. Laracca, P. Mercantini, S. Perretta, N. Padoy, B. Dallemagne, and P. Mascagni, "Statistical models to preoperatively predict operative difficulty in laparoscopic cholecystectomy: A systematic review," Surgery, vol. 171, no. 5, pp. 1158-1167, 2022. doi: 10.1016/j.surg.2021.10.001
56. M. Norouzi, A. A. Haghdoost, and M. Mobasher, "Ethical Challenges in Precision Medicine from the Perspective of Health EquityEthical Challenges in Precision Medicine from the Perspective of Health Equity," Iranian Journal of Medical Ethics and History of Medicine, 2024. doi: 10.18502/ijme.v16i5.15941
57. Z. Luo, M. Li, X. Kong, Y. Li, W. Li, Z. Tian, and Y. Duan, "Advance on fiber opticbased biosensors for precision medicine: From diagnosis to therapy," Interdisciplinary Medicine, vol. 1, no. 4, p. e20230022, 2023. doi: 10.1002/inmd.20230022
58. D. Y. Zhang, and F. H. Bai, "Research trends and hotspots in the immune microenvironment related to hepatocellular carcinoma: A bibliometric and visualization study," World Journal of Gastrointestinal Oncology, vol. 16, no. 7, p. 3321, 2024.
59. G. O. Schaefer, E. S. Tai, and S. Sun, "Precision medicine and big data: The application of an ethics framework for big data in health and research," Asian Bioethics Review, vol. 11, no. 3, pp. 275-288, 2019.
