Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2015; 7(8): 152-159
Published online Aug 27, 2015. doi: 10.4240/wjgs.v7.i8.152
Management and outcome of recurrent gallstone ileus: A systematic review
Shovkat Ahmad Mir, Zeiad Hussain, Christine Ann Davey, Glenn Vincent Miller, Srinivas Chintapatla
Shovkat Ahmad Mir, Zeiad Hussain, Glenn Vincent Miller, Srinivas Chintapatla, Department of General Surgery, York Teaching Hospital, York YO31 8HE, United Kingdom
Christine Ann Davey, Research and Development Unit, York Teaching Hospital, York YO31 8HE, United Kingdom
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: Authors declare no conflict of interest.
Data sharing statement: Not applicable, this is secondary research based on data from published case reports.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Srinivas Chintapatla, MBBS, MS, FRCS (Glasg), FRCS (Ed), Consultant Colorectal Surgeon, Department of General Surgery, Colorectal Unit, York Teaching Hospital, Wigginton Road, York YO31 8HE, United Kingdom.
Telephone: +44-01904-721154 Fax: +44-01904-726886
Received: March 20, 2015
Peer-review started: March 21, 2015
First decision: April 10, 2015
Revised: June 3, 2015
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: August 27, 2015

AIM: To help the surgeon in decision making when treating a patient with recurrent gallstone ileus (RGSI).

METHODS: A systematic review related to RGSI was performed using the databases CINAHL, EMBASE, MEDLINE via PubMed from May 1912 to April 2015. All languages were included and the grey literature was also searched. The abstracts were explored for relevance to the topic and full texts obtained as appropriate. A manual search was carried out by scrutinising the reference lists of all the full text articles and further articles were identified and obtained. Total of 903 articles were identified, 656 were excluded after abstract review, 247 full text articles were reviewed and 91 articles selected for final analysis. There were 113 cases of RGSI.

RESULTS: There were 113 cases of RGSI reported in 91 articles. The majority of the recurrences, 62.6%, occurred within 6 wk of the index event. The male to female ratio was 1:7. The mean age was 69.6 years (SD 11.2) with a range of 38-95 years. The small bowel was the commonest site of impaction (92.2%). Treatment data was available for 104 patients. The two main operations performed were: (1) Enterolithotomy without repair of biliary fistula in 70.1% of all patients with a procedural mortality rate of 16.4% (12/73) and (2) a single stage surgery approach involving enterolithotomy with cholecystectomy and repair of the biliary enteric fistula in 16.3% with a procedural mortality of 11.7% (2/17). A subset analysis over last 25 years showed mortality from eneterolithotomy was 4.8% while single stage mortality was 22.2%. Enterolithotomy alone was the commonest operation performed for RGSI with four patients (5.4%) having a further recurrence of gallstone ileus.

CONCLUSION: Enterolithotomy alone or followed by a delayed two-stage treatment approach is the preferred choice offering low mortality and reduced risk of recurrence.

Keywords: Recurrent gallstone ileus, Gallstone ileus, Biliary-enteric fistula, Intestinal obstruction

Core tip: Recurrent gallstone ileus, is an acute but rare surgical condition and there is no clear evidence at present as to the appropriate management of this surgical condition. This review will provide a framework to help decision making for this condition when confronted as an emergency by the general surgeon.