From the Guidelines
Cholecystoduodenal fistulas are relatively rare, occurring in approximately 0.14-0.5% of all biliary tract surgeries and representing about 60-70% of all cholecystoenteric fistulae. The exact incidence of cholecystoduodenal fistulas is not directly reported in the provided evidence, but based on the available data on bile duct injuries (BDIs) and cholecystoenteric fistulas, it can be inferred that cholecystoduodenal fistulas are a rare complication of biliary tract surgeries 1.
Key Points
- The overall BDI rate during laparoscopic cholecystectomy (LC) ranges from 0.32 to 0.52% according to a recent literature review by Pucher et al. 1.
- The prevalence of major injuries and bile leaks is reported to be around 0.28% and 0.46%, respectively 1.
- The rate of reconstructive surgery due to BDI ranges between 0.04 and 0.3% in various studies 1.
- A higher incidence of BDIs can be expected in cases of inflammation (acute or chronic) or emergency cholecystectomy 1.
Clinical Implications
- The diagnosis of cholecystoduodenal fistulas can be challenging due to nonspecific symptoms, and the condition is often discovered incidentally during surgery.
- Treatment typically involves cholecystectomy with fistula takedown and repair of the duodenal defect, though the surgical approach may need modification based on patient factors and local tissue conditions.
- The provided evidence highlights the importance of careful surgical technique, intraoperative cholangiography, and postoperative monitoring to minimize the risk of BDIs and cholecystoenteric fistulas 1.
From the Research
Incidence of Cholecystoduodenal Fistulas
- The incidence of cholecystoduodenal fistulas is reported to be around 0.5% to 0.9% of cholecystectomies 2.
- A study of 1500 patients who underwent laparoscopic cholecystectomy for gallstone disease found that 5 patients (0.33%) had a cholecystoduodenal fistula 3.
- Cholecystoduodenal fistulas are considered a rare complication of gallstone disease, with other types of fistulas such as cholecystocolonic and cholecystogastric fistulas being even less common 2, 4, 5.
- The exact incidence of cholecystoduodenal fistulas may vary depending on the population and the criteria used to diagnose the condition.
Diagnosis and Treatment
- Cholecystoduodenal fistulas can be diagnosed preoperatively using imaging techniques such as ultrasound and cross-sectional imaging 6, 5.
- Laparoscopic surgery is a feasible treatment option for cholecystoduodenal fistulas, with some studies reporting successful treatment without increased morbidity risk 3, 6, 4.
- Open surgery may also be necessary in some cases, particularly if there are complications such as bleeding or inflammation 4, 5.