Laparoscopic Management of Bouveret's Syndrome: A Surgical Case Series

Bouveret's syndrome is a form of gastric outlet obstruction characterised by gallstones traversing through a cholecystoduodenal fistula and lodging in the proximal duodenum and pylorus. This condition often requires complex surgical management due to disruption of the normal biliary and duodenal anatomy. The management approach is usually tailored to the patient's disease, the surgeon's and endoscopist's skills and instrument availability. The principles for treatment are ectopic gallstone extraction, management of duodenotomy, cholecystectomy and repair of cholecystoduodenal fistula. This case series presents three instances of Bouveret's syndrome, each involving gallstone impaction at a distinct location within the duodenum. All cases were performed in single-stage procedures. We have included a summary of the operative steps and described our techniques in detail. All patients underwent successful laparoscopic surgery with uneventful recovery, no reoperation, and no evidence of fistula recurrence or stricture on follow-up. Although this condition is rare, general surgeons should be familiar with the principles of managing a cholecystoduodenal fistula and seek early specialist input, as it carries a high risk of morbidity and mortality. Where feasible, a single-stage, minimally invasive approach should be considered, as it may reduce the need for multiple operations and improve overall outcomes.