Comparison of Surgical Treatments of Gallstone Ileus: Preliminary Report

• Published in: World journal of surgery 2003-04, Vol.27 (4), p.400-404
• Main Authors: Doko, Marko, Zovak, Mario, Kopljar, Mario, Glavan, Elizabet, Ljubicic, Neven, Hochstädter, Hrvoje
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Bowel Obstruction; Cholelithiasis - complications; Cholelithiasis - surgery; Digestive System Fistula - etiology; Digestive System Fistula - surgery; Digestive System Surgical Procedures - methods; Female; Gallbladder Diseases - surgery; High Mortality; Humans; Ileal Diseases - surgery; Ileus; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Operating Time; Small Bowel; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-002-6569-0

Gallstone ileus is an uncommon cause of small bowel obstruction, accounting for only 1% to 4% of all intestinal obstructions. In the group of patients over 65 years of age, gallstones cause about 25% of all non‐strangulated obstructions of the small bowel. Gallstone ileus is burdened with high mortality rate, ranging from 12% to 18%, and most patients are of advanced age, with many other concomitant diseases that may increase the operative risk. The purpose of this study was to compare the two investigated surgical procedures: treatment of intestinal obstruction alone or combined with urgent cholecystectomy and fistula repair. Analysis of 30 patients undergoing operation for gallstone ileus at the Clinical Hospital “Sestre milosrdnice” between 1985 and 2001 is presented. Patients were treated either for ileus alone (group 1, 11 patients) or as one‐stage procedure with urgent fistula closure (group 2, 19 patients). Operating time was significantly longer for the one‐stage procedure. Complications occurred in 3 of 11 patients (27.3%) from group 1 and in 11 of 18 patients (61.1%) from group 2 (one tailed, p = 0.043). One patient in group 1 died and two patients in group 2 died. Urgent fistula repair was significantly associated with the occurrence of complications (odds ratio [OR] 12.1, 95% confidence internal [95% CI] 1.2–121.5). Simple enterotomy should be the procedure of choice for patients with gallstone ileus. The one‐stage procedure including urgent fistula repair should be reserved only for highly selected patients with absolute indications.