DOI: 10.11648/j.ijcems.20261203.12 ISSN: 2469-8032

Rational Surgical Management of Rare Complications of Cholelithiasis

Vladimir Glabay, Vitaliy Tsvetkov, Rashid Askerkhanov, Zaira Eldarova, Vakhtang Gobedzhishvili
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Most patients with gallstone disease undergo elective surgery. However, some patients do not undergo surgery because, despite long-term treatment, they experience only rare complications, the incidence of which does not exceed 1.4%. Rare complications of gallstone disease include external biliary fistulas, cholecystocholedocheal fistulas or Mirizzi syndrome, micro or "large" choledocholithiasis, "shrunken" gallbladder, gallbladder calcification (porcelain gallbladder), and others. Recognizing these rare complications of gallstone disease presents significant challenges, and various types of imaging are the primary methods for their detection. Development of rational surgical management to improve treatment outcomes of rare complications of cholelithiasis. A total of 5,449 patient records for cholelithiasis were reviewed. Of these, 3,332 (61%) were admitted for emergency indications and 2,117 (39%) for elective surgery. Of all patients with calculous cholecystitis, 96 had rare complications, representing a 1.74% incidence. The male-to-female ratio was 1: 4, and the average age of the patients was 70 years. A review of the anamnestic data revealed that the patients had suffered from cholelithiasis for between 5 and 57 years. Of the 96 patients operated on for rare complications of cholelithiasis, 16 (17%) were operated on for emergency indications with acute cholecystitis, 30 (32%) due to the ineffectiveness of conservative treatment, and 14 (15%) due to the failure of endoscopic papillotomy undertaken to resolve mechanical jaundice and cholangitis or due to the development of obstructive cholelithiasis. A study of clinical observations of patients with rare complications of gallstone disease revealed the absence of any pathognomonic manifestations. Only in cases of spontaneous external biliary fistulas, with bile leaking onto the anterior abdominal wall, was the diagnosis immediately apparent. The primary surgical procedure for cholecystodigestive fistulas is their dissection, cholecystectomy, and fistula closure. In cases where choledocholithiasis associated with Mirizzi syndrome cannot be resolved with endoscopic papillotomy, a biliary anastomosis is necessary. The developed surgical approach for rare complications of cholelithiasis aimed at early recognition and prompt surgical intervention led to a favorable short-term outcome in 85 of 96 patients. The overall mortality rate was 11.6% (n=11). The main cause of rare complications of cholelithiasis is a prolonged and/or asymptomatic course of the disease. The best method for preventing this disease is timely surgery during the cold period, preferably minimally invasive. Decompensation of concomitant diseases against the background of a combination of complications of cholelithiasis primarily leads to a fatal outcome.

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