Laparoscopic repair of various types of biliary-enteric fistula: three cases

Abstract

Biliary-enteric fistula is one of the reasons for converting from laparoscopic cholecystectomy (LC) to open surgery. Here we present three cases of various types of biliary-enteric fistula treated successfully by laparoscopic surgery. Two cases were diagnosed preoperatively, and the remaining case intraoperatively. The first patient had a cholecystoduodenal fistula with a common bile duct stone. The second patient had cholecystocolic and choledochoduodenal fistulas with a common bile duct stone, and the third patient had a cholecystogastric fistula. The fistulas were repaired laparoscopically by intracorporeal suturing or with an endoscopic linear stapling device. All the patients had good postoperative courses without any postoperative complication. Our experience has shown us that with advances in surgical skills and instruments, laparoscopic surgery for biliary-enteric fistula can be adopted as the first treatment choice regardless of the preoperative diagnosis.

Cholecystocolonic fistula: facts and myths. A review of the 231 published cases

“…Cholecystoenteric fistula was considered a formal contraindication to the laparoscopic approach until the early 1990s [168]. Recently, laparoscopic procedures have been proposed for patients with CCF [2, 3, 104, 107, 109, 110, 114, 121, 122, 127, 129, 132, 135, 146, 152, 155]. Although these authors support the feasibility of the entire procedure by the laparoscopic approach, some of them report long operating times and, despite the small series of patients, a considerable number of conversions [3, 132], in some cases due to iatrogenic colonic perforation [3].…”

“…We identified 160 articles from 1950 to 2006 concerning 231 cases of CCF, which are the object of our review []. The analysis of diagnostic imaging and treatment is mainly focused on present tools, as proposed in recent papers.…”

“…Some aspects of recently proposed surgical treatments for uncomplicated CCF have been analyzed, namely the effectiveness of the laparoscopic procedure, the sequence of resections (cholecystectomy and colonic resection), the modality of colonic suturing, and the potential need for a diversion. Since 1994, 16 articles [2, 3, 104, 107, 109, 110, 114, 121, 122, 127, 129, 132, 135, 146, 152, 155] have reported on laparoscopic (or laparo‐assisted) [129] treatment of CCF in 36 elective patients. Owing to the nature of those articles, which were mostly case reports or large series including different types of bilio‐enteric fistulas, data are largely incomplete, especially regarding duration of surgery.…”

“…Intraoperative cholangiography is also reported to have led to the identification of concomitant CBD stones (see Table 1). [3], [7], [9], [12], [22], [23], [26], [27], [33], [35], [38], [39], [41], [45], [52], [53], [57], [64], [68], [69], [76], [81], [87], [93], [95], [123] Cholecystogastric 2 [46], [118] Duodenocolic 2 [58], [81] Cholecystocholedochal 1 [76] Cholecysto-internal biliary duct 1 [137] Cholecystocutaneous 1 [160] Choledochoduodenal 1 [146] Gastrocolonic (after partial gastrectomy)…”

Laparoscopic End-to-End Choledochocholedochostomy for Bile Duct Injury During Laparoscopic Cholecystectomy

“…However, after gaining a measure of experience with laparoscopic suturing, the intracorporeal suturing technique be- comes easier. We have previously gained a good deal of experience with laparoscopic biliary surgery [8][9][10][11] and this made it possible for us to perform the operation we report here.…”