Succcessful laparoscopic treatment of cholecystoduodenal fistula

Cholecystoduodenal fistula (CD) is a rare complication of gallstone disease. Laparoscopic stapling techniques have been reported as feasible methods for treating this fistula, however these procedures are not always performed successfully. We have reported five cases of CD diagnosed intraoperatively, managed successfully by laparoscopic approach.

During the 3-year period, from 2007 to 2009, 1500 patients underwent LC for gallstone desease, five of them (3.3%), who presented with classic symptoms of symptomatic cholelithiasis, intraoperatively CD were found. Data were collected on patients' age, sex, pre-operative diagnoses, operative methods, morbidity and management. Laparoscopic surgery was performed using the standard three trocars technique.

All patients were females, 67 years old on average. They had gallstones detected by abdominal ultrasound, but CD's were found during operative treatment of gallstones. In three cases CD was completely mobilized with a combination of blunt and sharp dissection and divided using the endoscopic linear stapling device. In the other two cases after division of the cystic duct and artery the gallbladder was dissected from the liver bed, leaving just the fistulous connection to the duodenum. Then division of the fistula was completed using the same stapling device. All five patients had uneventful postoperative course. The hospital stay of five patients ranged from 5 do 10 days (median 6 days).

CD does not preclude a laparoscopic approach. With more experience and improved techniques, most of these cases could be performed laparoscopically, with all of the advan-tages of minimally invasive surgery.