Gallstone ileus: retrospective review of a single centre's experience using two surgical procedures

Riaz N, Khan MR, Tayeb M
Correspondence: Dr Muhammad Rizwan Khan, doctormrkhan@yahoo.com

ABSTRACT
Introduction Gallstone ileus is responsible for 1-3 percent of cases of mechanical small bowel obstruction. Debate continues regarding choice of optimal surgical procedure. One-stage procedure includes enterolithotomy, cholecystectomy and repair of fistula at the same setting, whereas staged procedure includes enterolithotomy alone, with fistula repair at a later stage. This study aims to determine factors influencing choice of surgical procedure in patients with gallstone ileus.
Methods Data was collected for patients diagnosed with gallstone ileus between 1990 and 2005. Five patients underwent enterolithotomy alone (Group 1), while the remaining five patients underwent enterolithotomy with cholecystectomy and repair of fistula as a single stage procedure (Group 2).
Results In Group 1, patients presented late with deranged physiological parameters and pre-existing comorbidities accounting for an American Society of Anesthesiologists (ASA) score of 3 or above. In Group 2, patients presented early with preserved physiological status accounting for an ASA score of 2. The mean operative time was 126 +/- 23 minutes in Group 1 and 245 +/- 54.4 minutes in Group 2. There was no mortality, three patients in Group 1 had superficial wound infection, and one patient in Group 2 had injury to the common bile duct necessitating hepaticojejunostomy. The mean follow-up period was 3.5 +/- 1.5 years. None of the patients in both groups had recurrent symptoms requiring further intervention.
Conclusion Choice of surgical procedure was largely determined by the clinical status of the patient. Single-stage procedure was performed in haemodynamically-stable patients, while enterolithotomy alone was considered sufficient for unstable patients.

Keywords: biliary-enteric fistula, cholecystoduo-denal fistula, enterolethotomy, gallstone ileus, small bowel obstruction
Singapore Med J 2008; 49(8): 624-6