Minimally invasive management of gallstone ileus with cholecystoduodenal fistula

Feasibility of Laparoscopic-Assisted Approach in Management of Gallstone Ileus

“…Cholecystoenteric fistulas have also been suggested to predispose to gallbladder carcinoma or recurrent episodes of gallstone ileus, 7 which supports the need to treat the fistula. 10 There remains a debate on the treatment of fistula because of the high postoperative mortality rate of 17 per cent. Thus, some authors suggest this procedure should only be performed on healthy patients and in those with no remaining gallstones in the gallbladder.…”

“…There remains lack of data on how to manage nonhealthy patients with multiple gallstones and productive cholecystoduodenal fistula. 10 Some have suggested laparoscopic enterolithotomy and endoscopic removal of concomitant gallstones, as well as biopsies performed in the process to eliminate gallbladder cancer. 2,10 In recent years, laparoscopic approach has shown to be more beneficial for patients.…”

“…10 Some have suggested laparoscopic enterolithotomy and endoscopic removal of concomitant gallstones, as well as biopsies performed in the process to eliminate gallbladder cancer. 2,10 In recent years, laparoscopic approach has shown to be more beneficial for patients. The benefits of the laparoscopic approach are as follows: 1) Prevents unnecessary laparotomies in undiagnosed cases, 2) shorter hospital stay, 3) reduce morbidity.…”

Robotic management of primary cholecystoduodenal fistula: A case report and brief literature review

“…5 Untreated CDF can lead to gallstone ileus, perforation, necrosis, sepsis, or gallbladder carcinoma. 5,8,9 A complication unique to biliary fistulas is known as Bouveret's syndrome, where the stone migrates through the fistula and impacts in the bowel, which is diagnosed when Rigler's triad of pneumobilia, small bowel distension, and ectopic gallstone is present on imaging. 9,10 Traditionally, CDFs were managed with open surgery until the first laparoscopic approach in 1995.…”

“…9,10 Traditionally, CDFs were managed with open surgery until the first laparoscopic approach in 1995. 1 However, the laparoscopic approach continues to have a conversion rate to the open approach of up to 70% 8,11 and the open approach carries a high morbidity rate with serious complications occurring in 17.5% of patients. 12 Robotic surgery offers unique advantages for biliary surgery such as improved visibility, dexterity, stability, and manoeuvrability due to the ability to position the camera and tools at precise angles and around tight corners.…”