Bilo-enteric fistula (BEF) at laparoscopic cholecystectomy: review of ten year's experience

BEF is a rare complication of gallstone disease with reported incidence of up to 4.8%. Most are diagnosed intra-operatively and often requires conversion to open surgery. This review assesses the feasibility of laparoscopic management of BEF found at the time of laparoscopic cholecystectomy over ten-year period.

All patients undergoing elective laparoscopic cholecystectomy by a single surgeon (PK) between 1996 and 2006 were prospectively entered in a database and analysed.

Out of 824 laparoscopic cholecystectomy, ten cases of BEF were identified at operation (1.2%, age 14-88 years, median=62). These were cholecysto-duodenal (7), cholecysto-colonic (1), cholecysto-choledocho-duodenal (1) and choledocho-duodenal (1). Two out of ten were converted to open surgery (20%) compared to overall conversion rate of 2.8% (23/824). Eight cases were successfully completed laparoscopically; endostapler was used in six patients to transect the fistula and two patients had the defect repaired by intra-corporeal sutures. No major complications were seen. One patient had a prolonged hospital stay for social reason.

BEF is often detected intra-operatively and most can be managed laparoscopically successfully. Endostapling avoids peritoneal contamination and reduces operative time.