| A comparison of two surgical strategies for the emergency treatment of gallstone ileus. | |
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MedLine Citation:
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PMID: 14985844 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: Debate currently exists regarding the appropriate surgical strategy for emergency treatment of gallstone ileus. This relates to the need for definitive biliary tract surgery after relief of mechanical obstruction. Our study reviews treatment by enterolithotomy alone and enterolithotomy combined with definitive biliary tract surgery and fistula closure to determine if there is advantage of one treatment option over the other. METHODS: The clinical, operative and follow-up data on 19 consecutive patients treated by emergency surgery for gallstone ileus from January 1992 to December 2000 was retrospectively reviewed. RESULTS: There were 15 women and four men, with a mean age of 74.6 (range 62-91) years. Pre-operative diagnosis was made in only nine of 19 patients. Enterolithotomy alone (E group) was performed in seven patients and enterolithotomy with cholecystectomy and fistula closure (E+C group) in 12 patients. In the E group, more patients had significant co-morbidity as identified by poorer American Society of Anesthesiologists (ASA) status, poorer pre-operative status (shock at presentation) than in the E+C group. Operative time was significantly shorter in the E group. However, there were no significant differences in morbidity, and both groups had zero mortality. CONCLUSION: Both procedures can be carried out safely and with zero mortality. Relief of obstruction remains the mainstay of treatment. The better surgical option in our series is enterolithotomy alone. It is safe in both low and high-risk patients, and requires a shorter operating time as it is technically less demanding. In the longer term, the remnant fistula also does not appear to lead to further complications. |
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Authors:
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Y M Tan; W K Wong; L L P J Ooi |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Singapore medical journal Volume: 45 ISSN: 0037-5675 ISO Abbreviation: Singapore Med J Publication Date: 2004 Feb |
Date Detail:
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Created Date: 2004-02-26 Completed Date: 2004-06-03 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0404516 Medline TA: Singapore Med J Country: Singapore |
Other Details:
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Languages: eng Pagination: 69-72 Citation Subset: IM |
Affiliation:
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Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608. gsutym@sgh.com.sg |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Digestive System Surgical Procedures / methods* Emergencies Female Gallstones / complications, surgery* Humans Ileus / etiology, surgery* Intestinal Fistula / etiology, surgery Intestinal Obstruction / etiology, surgery* Male Middle Aged Retrospective Studies Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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