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Surgeon. 2010 Apr;8(2):67-70. doi: 10.1016/j.surge.2009.10.010. Epub 2010 Feb 11.

Bilo-enteric fistula (BEF) at laparoscopic cholecystectomy: review of ten year's experience.

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  • 1Department of Surgery, Queen's Hospital, Belvedere Road, Burton-on-Trent, Staffs DE13 0RB, United Kingdom.



BEF is a rare complication of gallstone disease with reported incidence of up to 4.8%. Most are diagnosed intra-operatively and often requires conversion to open surgery. This review assesses the feasibility of laparoscopic management of BEF found at the time of laparoscopic cholecystectomy over ten-year period.


All patients undergoing elective laparoscopic cholecystectomy by a single surgeon (PK) between 1996 and 2006 were prospectively entered in a database and analysed.


Out of 824 laparoscopic cholecystectomy, ten cases of BEF were identified at operation (1.2%, age 14-88 years, median=62). These were cholecysto-duodenal (7), cholecysto-colonic (1), cholecysto-choledocho-duodenal (1) and choledocho-duodenal (1). Two out of ten were converted to open surgery (20%) compared to overall conversion rate of 2.8% (23/824). Eight cases were successfully completed laparoscopically; endostapler was used in six patients to transect the fistula and two patients had the defect repaired by intra-corporeal sutures. No major complications were seen. One patient had a prolonged hospital stay for social reason.


BEF is often detected intra-operatively and most can be managed laparoscopically successfully. Endostapling avoids peritoneal contamination and reduces operative time.

Copyright 2009 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

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