From the Research
Laparoscopic management of cholecystoenteric fistulae, including cholecysto-colic and cholecysto-duodenal fistulae, is a safe and feasible approach in experienced hands, with a high success rate and minimal morbidity, as demonstrated by the most recent study 1. The key learning points from a case of a young female who underwent laparoscopic cholecystectomy and was found to have two separate cholecystoenteric fistulae include:
- The rarity of dual fistulae in young patients, with most cases reported in older adults 2, 3
- The importance of approaching all laparoscopic cholecystectomies with caution, regardless of preoperative risk assessment, due to the potential for unexpected findings such as cholecystoenteric fistulae 4, 5
- The need for robust pathways when performing these procedures at offsite surgical hubs, including having emergency equipment available and proper ambulatory follow-up pathways for postoperative care 1
- The role of imaging studies, such as computed tomography, in diagnosing cholecystoenteric fistulae and guiding surgical management 1
- The effectiveness of laparoscopic management of cholecystoenteric fistulae, including the use of endostaplers and intracorporeal sutures, in achieving high success rates and minimal morbidity 2, 5, 1
Some of the key findings from the studies include:
- A high success rate of laparoscopic management of cholecystoenteric fistulae, with minimal morbidity and mortality 2, 5, 1
- The importance of a high index of suspicion for cholecystoenteric fistulae during laparoscopic cholecystectomy, particularly in patients with gallstone disease 4, 3
- The role of experienced laparoscopic surgeons in achieving successful outcomes in the management of cholecystoenteric fistulae 1
- The potential for spontaneous resolution of intestinal obstruction in gallstone ileus, and the importance of considering this possibility in the management of patients with cholecystoenteric fistulae 1