LAPAROSCOPIC REPAIR OF CHOLECYSTODUODENAL FISTULAS

Since the first laparoscopic cholecystectomy in 1987 by Mouret, the sc ope of biliary surgery available to a laparoscopic surgeon has increas ed. In the early days of the procedure there were several accepted con traindications. Some of these were acute cholecystitis, morbid obesity , adherent gallbladder, jaundiced patients, ductal calculi, and biliar y tract anomalies. In a series of 300 laparoscopic cholecystectomies w e encountered five cholecystoduodenal fistulae. It was possible to dea l with four fistulae laparoscopically. Two patients underwent a laparo tomy, one for a failed laparoscopic repair of cholecystoduodenal fistu la and the other for several common bile duct (CBD) stones, which coul d not be removed laparoscopically via the cystic duct. We maintain tha t with increasing expertise and improved instrumentation, most cases o f cholecystoduodenal fistula could be dealt with laparoscopically.