Cholecystectomy and fistula closure versus enterolithotomy alone in gallstone ileus

Abstract

Background: The management of gallstone ileus is controversial. This study compared the results of simple enterolithotomy with those of enterolithotomy, cholecystectomy and fistula closure.

Methods: A retrospective analysis was made of 25 patients with a mean age of 75 (range 55-84) years. Enterolithotomy was performed in 16 patients (group 1) and cholecystectomy and fistula closure were added in nine patients (group 2).

Results: The diagnosis was made before operation in 12 patients, and was associated with previous biliary disorder (P = 0.03) and pneumobilia (P < 0.001). Postoperative morbidity occurred in eight patients in group 1 and in six in group 2. Three patients died in each group; all but one of the deaths were unrelated to the surgical procedure. There was no relationship between age and mortality, and patients in American Society of Anesthesiologists (ASA) classes III and IV did not have higher rates of morbidity or mortality than those in ASA classes I and II.

Conclusion: Evidence from this study does not support one-stage enterolithotomy, cholecystectomy and fistula closure as the procedure of choice; simple enterolithotomy is appropriate in most patients. However, the one-stage procedure may be acceptable in patients at low risk.