Treatment of cholecystoduodenal fistula in the era of laparoscopy.

INTRODUCTION: At first, laparoscopic cholecystectomy was considered unsuitable for patients presenting biliary tract diseases. This study seeks to demonstrate cholecystoduodenal fistula is not a contraindication for laparoscopic cholecystectomy, and it can be performed without a higher risk for the patient. PATIENTS AND METHODS: A retrospective study has been completed on laparoscopic biliary pathology from 1992 to 1999 (191 urgent and 877 elective choice surgeries). 302 cases (28%) are of complicated biliary pathology. We report on 14 cholecystoduodenal fistulae, 3 cholecystocolonic fistulae, and 2 cholecystogastric fistulae. RESULTS: Only in 5 patients with cholecystoduodenal fistula was the operation successfully completed by laparoscopy. Conversion to open surgery was because of bleeding (5 cases), difficulty for colon suture (2 cases), and inflammation of the gallbladder with the duodenum (7 cases). An endo-GIA 35 was used to transect the fistula. All patients were discharged after 4 or 5 days without wound infection, and they have been evaluated at 3 and 12 months, without problems. CONCLUSION: Cholecystoduodenal fistula can no longer be considered a contraindication for laparoscopic treatment, and it does not increase morbidity risk.

[Carcinoid tumor of the Vater's ampulla]. / Tumor carcinoide de la ampolla de Vater.

We report a patient with biliary obstruction of two years evolution. Blood chemistry evaluation was compatible with obstructive jaundice. Endoscopy and CT were suggestive of ampullary tumor. At laparotomy, the biopsy specimen was diagnosed as carcinoid tumor, and was treated by a Whipple's procedure.