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Advantages of one-stage repair in case of gallstone ileus.

BACKGROUND/AIMS
The commonly used procedure to treat gallstone ileus is enterolithotomy in combination with late cholecystectomy for persistent symptoms. It is related to a high mortality rate up to 20%. To date it has been impossible to reduce the mortality associated with this accepted surgical technique.


PATIENTS AND METHODS
A seven-year retrospective study with a follow up over a period of four years and five months. Sixteen patients with gallstone ileus were entered into the study. Twelve patients were female and fourteen were more than 70 years of age. Fourteen patients were treated by enterolithotomy as well as additional cholecystectomy and resection of the fistula in a one-stage repair.


RESULTS
Mortality during hospitalization amounted to one (6%) and postoperative complications to five patients (31%). Follow-up over a period of four years and five months showed one patient had died 3 years postoperatively of an advanced renal tumor. All other patients were alive and without symptoms.


CONCLUSION
Our results prove that the concomitant one-stage repair for gallstone ileus significantly reduces the overall mortality rate compared to the single enterolithotomy alone and later cholecystectomy based on patient symptoms.