Cholecystolithotomy, a new approach to reduce recurrent gallstone ileus

Abstract

The incidence of gallstone ileus (GSI) is increasing. Current treatment options include enterolithotomy with or without cholecystectomy and repair of the biliodigestive fistula. Although most surgeons defer the management of the biliodigestive fistula to avoid the associated morbidity and mortality, this can lead to increased rate of recurrence of GSI by the remaining gallstones. More than 130 cases of recurrent GSI were reported in published works, and the incidence of recurrent GSI is reported to be between 5% and 20%. Some cases of second recurrent attacks have also been reported. Most cases were reported in elderly women with faceted stones during the first 2 months from the first episode of GSI. This article reviews the current treatment options for more than 4,300 reported cases of GSI. A treatment algorithm is recommended based on the severity of the inflammation around the gallbladder, including cholecystolithotomy as a third treatment approach that aims to reduce the risk of recurrent GSI.

Keywords: Cholecystectomy; cholecystolithotomy; gallstone; ileus; recurrent.

Figure 1

Treatment algorithm for gallstone ileus including three approaches of treatment depending on the patient's clinical condition, the extent of inflammation around the gallbladder, presence of remaining stones in the gallbladder, and the surgeon's expertise.