Laparoscopic approach to cholecystoenteric fistula: A single-centre experience and systematic review

Background

Cholecystoenteric fistula (CEF) is a rare but well recognized complication of gallstones. Traditionally, surgical management was by open approach. We aim to report on the safety and outcomes of laparoscopic surgery for CEF and present a systematic review of literature.

Methods

All patients who underwent laparoscopic cholecystectomy in our institution from January 2015 to December 2023 were retrospectively reviewed. We identified all patients with CEF for data collection, including demographics, clinical presentation, operative details, and outcomes. Systematic review of literature reporting on safety and outcomes of laparoscopic surgery for CEF was performed.

Results

4937 patients underwent laparoscopic cholecystectomy over a nine-year period between January 2015 to December 2023.19 patients were diagnosed with CEF. Mean age was 63.7 years. 14 patients (73.7 ​%) were diagnosed intra-operatively. Pneumobilia was a key radiological feature leading to pre-operative diagnosis in three patients. Laparoscopic surgical stapler was most common fistula closure method with six cases (31.6 ​%), followed by laparoscopic handsewn closure in five patients (26.3 ​%). Open conversion rate was 36.8 ​%. Three patients (15.8 ​%) had minor complications, and one patient (5.3 ​%) had bile leak. There was one 30-day readmission. There were zero mortalities in our cohort. Median time to diet and length of stay was 2.5 and 6 days respectively. Following exclusions, the systematic review identified seven studies with a total of 145 patients. Major complication rate was 2.8 ​% and mortality 1.4 ​% among those included.

Conclusion

Laparoscopic surgery is safe and feasible in management of cholecystoenteric fistula. It has good outcomes in surgeons familiar with laparoscopic skills.