Transvaginal Hybrid NOTES Procedure for Treatment of Gallstone Ileus

Abstract

Gallstone ileus is a rare mechanical bowel obstruction, and previously reported cases have been treated laparoscopically with good results. Although transvaginal hybrid NOTES without a minilaparotomy has been reported to decrease the incidence of surgical wound complications, to our knowledge, this procedure has not been used previously to treat gallstone ileus. We present a case of a 63-year-old woman who underwent transvaginal hybrid NOTES procedure for treatment of gallstone ileus. This case was admitted to our hospital following acute-onset abdominal pain and vomiting. We diagnosed gallstone ileus with cholecystoduodenal fistula by computed tomography and performed totally laparoscopic surgery using only three 5 mm abdominal ports with transvaginal specimen extraction and enterectomy. The patient's postoperative course was uneventful, and laparoscopic cholecystectomy and fistula repair were performed 8 months after the initial surgery. The patient experienced additional pain relief and good cosmetic outcomes. In conclusion, using transvaginal hybrid NOTES may become a future option to minimize the invasiveness of other laparoscopic procedures.

Feasibility of Laparoscopic-Assisted Approach in Management of Gallstone Ileus

“…5,6 Complications of gallstone ileus recurrence in a patient treated with enterolithotomy alone is 5 to 8 per cent. 1,7,8 More than 50 per cent of those with recurrence will present within the first month, and the remainder do so within two years. 1,5,6 It is still debated that recurrence cases may warrant consideration for elective cholecystectomy and or repair of cholecystoenteric fistulas.…”

“…An interesting article explored a transvaginal approach to performing an enterectomy and stone extraction, and proposed that this technique may provide potential for lower risk surgery. 8 The two-stage procedure includes enterolithotomy followed by cholecystectomy and repair of biliodigestive fistula after four to six weeks. This alternative treatment is primarily suggested for patient with recurrent biliary symptoms.…”