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WJOLS

Cholecystoduodenal Fistula is not the Contraindication for Laparoscopic Surgery
Contraindication for Laparoscopic Procedure laparoscopically with closure of the cholecystoduodenal
fistula. In the risky patient, staged laparoscopic management
The Mirizzi syndrome refers to common hepatic duct
obstruction caused by an extrinsic compression from an of gallstone ileus and the associated cholecystoduodenal
impacted stone in the cystic duct. It is often not recognized fistula is feasible and seems to be safe. In high risk cases,
preoperatively, which can lead to significant morbidity and imaging of the biliary tree is must to detect silent
biliary injury, biliary leakage and biliary peritonitis due to choledocholithiasis, which also can be managed along with
distorted anatomy in laparoscopic surgery. and safely by the laparoscopic and endoscopic approach. 14
In a series of 300 laparoscopic cholecystectomies, the
RESULTS authors encountered five cholecystoduodenal fistulae. It was
possible to manage four fistulae laparoscopically. Two
In 1991, Miguel Velez et al (surgical endoscopy) reported a patients underwent a laparotomy, one for a failed
case of successful laparoscopic repair of cholecystoduodenal
fistula incidentally noticed in cholecystectomy. 2 laparoscopic repair of cholecystoduodenal fistula and the
In 1999, Yashimota et al performed the laparoscopic other for several common bile duct (CBD) stones, which
surgery of cholecystoduodenal fistula and cholelithiasis. could not be removed laparoscopically via the cystic duct.
With the use of a flexible HD video scope, flexible retractor Most cases of cholecystoduodenal fistula could be dealt
7
and endoscopic transecting stapler, laparoscopic treatment with increasing expertise and improved instrumentation.
of cholecystoenteric fistulae was performed. 15 In 2007, Maciej et al conducted a study in which
In 2000, Scott et al treated two middle aged women 56-year-old woman with past history of 20 years colic pain
having acute exacerbations of chronic gallbladder disease in right hypochondriac region diagnosed as case of
with laparoscopic surgery. A cholecystoduodenal fistula cholelithiasis. Laparoscopic cholecystectomy was initiated,
diagnosed intraoperatively in each case. These fistulae were but following the diagnosis of cholecystoduodenal fistulas,
repaired laparoscopically using an endoscopic stapling device it was converted to an open cholecystectomy, postoperative
without complication. Each patient did well postoperatively recovery was without complication. Cholangiography
and was discharged on the second postoperative day in performed one week after surgery showed residual
good condition. 10 choledocholithiasis. 13
In 2001, Moreno et al conducted study on laparoscopic In 2006, Chowbey et al study was conducted to assess
biliary pathology from 1992 to 1999 (191 emergency and the use of different suturing modes. The operation could be
877 elective surgeries). A total of 302 cases (28%) were of completed laparoscopically in 59 patients. An endostapler
complicated biliary pathology; out of these they reported was used in 47 patients to transect the fistula and in
14 cholecystoduodenal fistulae, three cholecystocolonic 12 patients the defect in the bowel was repaired with
fistulae and two cholecystogastric fistulae. Only in five intracorporeal sutures. The mean postoperative hospital stay
patients with cholecystoduodenal fistula, the operation was was 5.2 days. All the patients are asymptomatic at a mean
successfully completed by laparoscopy. Conversion to open follow-up of 2.4 years. 12
surgery was because of bleeding (5 cases), difficulty for In 2010, Azra lactic et al reported five cases of CCDF
colon suture (2 cases) and inflammation of the gallbladder diagnosed intraoperatively, managed successfully by
with the duodenum (7 cases). An endo-GIA 35 was used laparoscopic approach. During the 3-year period, from 2007
to transect the fistula. All patients were discharged after 4 to 2009, 1500 patients underwent laproscopic chole-
or 5 days without wound infection, and they have been cystectomy for gallstone disease, only five of them (3.3%),
evaluated at 3 and 12 months without problems. 5 who presented with routine symptoms of symptomatic
In 2006, Chikamori et al (Japan) reported a case of cholelithiasis, intraoperatively CCDF were found.
cholecystocholedocholithiasis with cholecystoduodenal Laparoscopic surgery was performed using the standard
fistula diagnosed preoperatively and treated with a combined three trocars technique. All patients were females, 67 years
approach endoscopic sphincterectomy for the multiple CBD old on average. In three cases, CCDF was completely
stones and laparoscopic cholecystectomy and mobilized with a combination of blunt and sharp dissection
cholecystofistulectomy with the help of endoscopic linear and divided using the endolinear stapling device. In the other
stapling devices for the fistula closure. They concluded that two cases after division of the cystic duct and artery, the
laparoscopic cholecystofistulectomy by skilled laparoscopic gallbladder was dissected from the liver bed, leaving just
surgeons can be adopted as a first-choice treatment for the fistulous connection to the duodenum. Then division of
cholecystoduodenal fistula. 11 the fistula was completed using the same stapling device.
1n 2003, El Dhuwaib et al conducted study on gallstone All five patients had uneventful postoperative course. The
ileus and small bowel obstruction in elderly women. The hospital stay of five patients ranged from 5 to 10 days
enterolithotomy and cholecystectomy have been peformed (median 6 days). 4

World Journal of Laparoscopic Surgery, January-April 2011;4(1):41-46 45