Video-assisted laparoscopic enterolithotomy: new technique in the surgical management of gallstone ileus

Our goal was to analyze the results obtained with the surgical treatment of gallstone ileus using a new video-assisted laparoscopic technique. Six patients with gallstone ileus were admitted to the Hospital de Clínicas José de San Martín of Buenos Aires between March 1996 and April 1998. The patients' charts were retrospectively studied. Five of the six patients were women, with an average age of 71.2 years. Enterolithotomy was performed in four patients, laparoscopic enterolithotomy in one, and diagnostic laparoscopy with no need of further surgical treatment (because the calculus migrated to the colon) in the remaining patient. The postoperative complication rate was 33%. In one patient, acute pulmonary edema and sepsis developed, and death occurred in the immediate postoperative period (mortality rate, 16.6%). The average hospital stay was 6.6 days. The average follow-up was 16 months. No patient required treatment of the enterovesical fistula; all of them remained asymptomatic. One patient died as the result of evolution of vesicular adenocarcinoma. This approach represents a safe and feasible technique that may reduce the morbidity associated with the surgical treatment of gallstone ileus by guiding the surgical incision, preventing unnecessary laparotomies, and improving abdominal exploration.