Laparoscopic repair of cholecystoduodenal fistulae

Abstract

Since the first laparoscopic cholecystectomy in 1987 by Mouret, the scope of biliary surgery available to a laparoscopic surgeon has increased. In the early days of the procedure there were several accepted contraindications. Some of these were acute cholecystitis, morbid obesity, adherent gallbladder, jaundiced patients, ductal calculi, and biliary tract anomalies. In a series of 300 laparoscopic cholecystectomies we encountered five cholecystoduodenal fistulae. It was possible to deal with four fistulae laparoscopically. Two patients underwent a laparotomy, one for a failed laparoscopic repair of cholecystoduodenal fistula and the other for several common bile duct (CBD) stones, which could not be removed laparoscopically via the cystic duct. We maintain that with increasing expertise and improved instrumentation, most cases of cholecystoduodenal fistula could be dealt with laparoscopically.