Page 35 - WJOLS - Laparoscopic Journal

WJOLS

10.5005/jp-journals-10007-1114
REVIEW ARTICLE Cholecystoduodenal Fistula is not the Contraindication for Laparoscopic Surgery
Cholecystoduodenal Fistula is not the

Contraindication for Laparoscopic Surgery

Sanjeev Kumar Sareen
Director and Surgical Specialist, Sareen Hospital, Amritsar, Punjab, India

ABSTRACT

Cholecystoduodenal fistula is the complication of gallstone and it is difficult to diagnose this condition preoperatively, which is the reason
for conversion of laparoscopic to open cholecystectomy. Earlier laparoscopic cholecystectomy was considered unsuitable for such
difficult bilioenteric procedures. The laparoscope is fast becoming an important tool for the general surgeon, it make us capable of
handling the unforeseen events. This review article is to demonstrate the cholecystoduodenal fistula is not the contraindication for the
5
laparoscopy, now it can be performed without higher rate of risk with the innovation of better modalities available. The goal of study is
to introduce the proper awareness in laparoscopic surgeons regarding the feasibility and safety of the procedure.
Keywords: Cholecystoduodenal fistula (CCDF), Cholelithiasis, Gallstone ileus, Safe laparoscopic repair.

INTRODUCTION MATERIALS AND METHODS
Acute cholecystitis, acute pancreatitis, spontaneous We analyzed review of many multicenter studies about
gallbladder perforation, pericholecystic abscess, laparoscopic cholecystoduodenal repair and laparoscopic
cholecystoduodenal fistula, gallstone ileus and intestinal cholecystectomy. A literature search is performed using
obstruction are the complications of the gallstone different search engines, such as Google, Yahoo,
21
disease. Despite advanced perioperative care, morbidity SpringerLink, HighWire press, surgical endoscopy. Total
and mortality are still high in such cases because of 21 references from various international and national journals
(i) geriatric age group, with (ii) multiple co-morbid are selected for this review article. The authors of the various
conditions, (iii) prolonged undiagnosed chole- journal publications at different times collected the data
cystoduodenal fistula and (iv) gallstone ileus, (v) fluid commonly on basis of patient’s age, sex, preoperative
and electrolyte imbalance and (vi) late stage diagnoses, operative methods, morbidity and management
4
hospitalization. Untreated cholecystoduodenal fistula will for their studies. The criteria for selection were to reduce
lead to passage of the gallstones in the second part the risk of postoperative complications.
duodenum and will require enterotomy as emergency
along with major biliary surgery to overcome the CHOLECYSTODUODENAL FISTULA
complications caused by bowel occlusion. One stage
laparoscopic surgery can be performed in such abdominal The communication between the gallbladder and duodenum
emergency conditions which include removal of impacted secondary to severe cholecystitis and cholelithiasis may lead
stones, repair of fistula and cholecystectomy. One stage to perforation and abscess formation (Fig. 1). The gallstones
surgery is good option; it can be done to avoid the future can erode into the second part of duodenum and bigger
1
recurrence, later biliary complications and reoperations stones will cause gallstones ileus. Gallstone ileus is not the
in elderly old patients who usually have coexisting medical common cause of intestinal obstruction and was first
diseases, to prevent the morbidity and mortality. 3,4,17 described by Bartholin in 1654.
CCDF will affect the duodenal bulb and cause peptic Cholecystoenteric fistulas are a rare complication of
duodenal perforation leading to upper gastrointestinal (GI) gallstone disease and affect 3 to 5% of patients with
bleeding. 6 cholelithiasis. Most fistulas are diagnosed intraoperatively
12
and often requires conversion to open surgery. The study
AIMS AND OBJECTIVES was conducted to evaluate the incidence of different types
The cholecystoduodenal fistula is the rare complication of of internal biliary fistula (1.9%), incidence of upto 4.8%,
the cholelithiasis. The aim of the review study is to evaluate which demonstrate that most common type was
the safety and risk of complications when laparoscopic choledochoduodenal fistula (62%), followed by
approach is applied in the cases of cholecystoduodenal cholecystoduodenal fistula(19%), cholecystocholedochal
fistula. (11%), cholecystocolonic fistula (8%). In most of the

World Journal of Laparoscopic Surgery, January-April 2011;4(1):41-46 41