CHOLECYSTECTOMY AND FISTULA CLOSURE VERSUS ENTEROLITHOTOMY ALONE IN GALLSTONE ILEUS

Background The management of gallstone ileus is controversial. This st udy compared the results of simple enterolithotomy with those of enter olithotomy, cholecystectomy and fistula closure. Methods A retrospecti ve analysis was made of 25 patients with a mean age of 75 (range 55-84 ) years. Enterolithotomy was performed in 16 patients (group 1) and ch olecystectomy and fistula closure were added in nine patients (group 2 ). Results The diagnosis was made before operation in 12 patients, and was associated with previous biliary disorder (P = 0.03) and pneumobi lia (P < 0.001). Postoperative morbidity occurred in eight patients in group 1 and in six in group 2. Three patients died in each group; all but one of the deaths were unrelated to the surgical procedure. There was no relationship between age and mortality, and patients in Americ an Society of Anesthesiologists (ASA) classes III and IV did not have higher rates of morbidity or mortality than those in ASA classes I and II. Conclusion Evidence from this study does not support one-stage en terolithotomy, cholecystectomy and fistula closure as the procedure of choice; simple enterolithotomy is appropriate in most patients, Howev er, the one-stage procedure may be acceptable in patients at low risk.