{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:50:56Z","timestamp":1786121456096,"version":"build-2736575974"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"\n Background<\/jats:title>\n Laparoscopic cholecystectomy is the preferred treatment for acute cholecystitis with gallstones; however, severe local inflammation, tissue adhesions, and unclear anatomical landmarks during the acute phase may increase surgical difficulty and operative trauma. Therefore, optimization of the surgical dissection approach remains clinically important.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To explore the impact of different surgical approaches during laparoscopic cholecystectomy on perioperative recovery, inflammatory response, and stress state in patients with acute cholecystitis combined with gallstones, and to evaluate the clinical application value of the lateral approach vs. antegrade\/retrograde dissection techniques.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective controlled study reviewed the medical records of 150 patients with acute cholecystitis combined with gallstones who underwent laparoscopic cholecystectomy at our hospital from January 2023 to January 2025. Patients were not prospectively assigned to different surgical approaches; instead, eligible patients were retrospectively identified from existing medical records and grouped according to the surgical approach actually performed during laparoscopic cholecystectomy. The control group (\n n<\/jats:italic>\n \u2009=\u200975) underwent antegrade\/retrograde dissection laparoscopic cholecystectomy, while the observation group (\n n<\/jats:italic>\n \u2009=\u200975) underwent lateral approach dissection laparoscopic cholecystectomy. The two groups were compared in terms of perioperative indicators (operative time, intraoperative blood loss, time to first flatus, time to first ambulation, drainage tube retention time, hospital stay), pain [visual analogue scale (VAS)] scores, levels of inflammatory markers [interleukin-6 (IL-6), interleukin-8 (IL-8), C-reactive protein (CRP), tumor necrosis factor-\u03b1 (TNF-\u03b1)], stress response indicators [cortisol (Cor), adrenocorticotropic hormone (ACTH)], bile duct injury indicators [alkaline phosphatase (ALP), direct bilirubin (DBIL)], and incidence of complications.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The observation group had significantly lower intraoperative blood loss, drainage tube retention time, and hospital stay compared to the control group (\n P<\/jats:italic>\n \u2009&lt;\u20090.05). VAS score comparisons between the two groups showed significant differences in group effect (\n F<\/jats:italic>\n \u2009=\u200910.413), time effect (\n F<\/jats:italic>\n \u2009=\u200912.846), and interaction effect (\n F<\/jats:italic>\n \u2009=\u200911.319) (\n P<\/jats:italic>\n \u2009&lt;\u20090.05); within-group analysis showed that VAS scores at 24\u2005h and 48\u2005h after surgery were significantly lower than those at 12\u2005h after surgery in both groups, and VAS scores at 48\u2005h were lower than those at 24\u2005h (\n P<\/jats:italic>\n \u2009&lt;\u20090.05); between-group analysis showed that the observation group had lower VAS scores than the control group at 12\u2005h, 24\u2005h, and 48\u2005h postoperatively (\n P<\/jats:italic>\n \u2009&lt;\u20090.05). At postoperative day 3, IL-6, IL-8, CRP, TNF-\u03b1, Cor, and ACTH levels were significantly higher than preoperative levels in both groups, while ALP and DBIL levels were lower than preoperative levels; the magnitude of change was more significant in the observation group (\n P<\/jats:italic>\n \u2009&lt;\u20090.05). There was no statistically significant difference in the incidence of complications between the two groups (10.7% vs. 8.0%,\n P<\/jats:italic>\n \u2009&gt;\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Compared with antegrade\/retrograde approaches, the lateral approach to laparoscopic cholecystectomy provides better minimally invasive advantages in treating acute cholecystitis with gallstones. It more effectively reduces intraoperative bleeding and postoperative drainage time, alleviates postoperative pain and physiological stress response, and facilitates rapid postoperative recovery, without increasing the risk of complications. It is worthy of further clinical promotion.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1890877","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T05:29:06Z","timestamp":1786080546000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Lateral approach in laparoscopic cholecystectomy for acute cholecystitis with stones: advantages in reducing inflammation, stress, and enhancing recovery"],"prefix":"10.3389","volume":"13","author":[{"given":"Yujie","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Songbei Campus, the Fourth Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunhong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Songbei Campus, the Fourth Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.1002\/wjs.12219","article-title":"Immunohistochemical inflammation in histologically normal gallbladders containing gallstones","volume":"48","author":"Psaltis","year":"2024","journal-title":"World J Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2557","DOI":"10.1007\/s00268-020-05491-5","article-title":"Retrospective analysis of outcomes following percutaneous cholecystostomy for acute cholecystitis","volume":"44","author":"Kuan","year":"2020","journal-title":"World J Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.4240\/wjgs.v16.i4.1078","article-title":"Research on the prognostic value of adjusting intraperitoneal three-dimensional quality evaluation mode in laparoscopic cholecystectomy patients","volume":"16","author":"Zhou","year":"2024","journal-title":"World J Gastrointest Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3342","DOI":"10.3760\/cma.j.cn112137-20200418-01229","article-title":"Safety of laparoscopic cholecystectomy for gallbladder cancer: a meta-analysis","volume":"100","author":"Zhang","year":"2020","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1007\/s13304-022-01403-5","article-title":"Is fundus first laparoscopic cholecystectomy a better option than conventional laparoscopic cholecystectomy for difficult cholecystectomy? 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