Surgery for gallstone ileus: A nationwide comparison of trends and outcomes

Wissam J Halabi, Celeste Y. Kang, Noor Ketana, Kelly J. Lafaro, Vinh Q. Nguyen, Michael J. Stamos, David K. Imagawa, Aram N. Demirjian

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

INTRODUCTION:: Gallstone ileus is a mechanical bowel obstruction caused by a biliary calculus originating from a bilioenteric fistula. Because of the limited number of reported cases, the optimal surgical method of treatment has been the subject of ongoing debate. METHODS:: A retrospective review of the Nationwide Inpatient Sample from 2004 to 2009 was performed for gallstone ileus cases treated surgically by enterotomy with stone extraction alone (ES), enterotomy and cholecystectomy with fistula closure (EF), bowel resection alone (BR), and bowel resection with fistula closure (BF). Patient demographics, hospital factors, comorbidities, and postoperative outcomes were reported. Multivariate analysis was performed comparing mortality, morbidity, length of stay, and total cost for the different procedure types. RESULTS:: Of the estimated 3,452,536 cases of mechanical bowel obstruction from 2004 to 2009, 3268 (0.095%) were due to gallstone ileus-An incidence lower than previously reported. The majority of patients were elderly women (>70%). ES was the most commonly performed procedure (62% of patients) followed by EF (19% of cases). In 19%, a bowel resection was required. The most common complication was acute renal failure (30.44% of cases). In-hospital mortality was 6.67%. On multivariate analysis, EF and BR were independently associated with higher mortality than ES [(odds ratio [OR] = 2.86; confidence interval [CI]: 1.16-7.07) and (OR = 2.96; CI: 1.26-6.96) respectively]. BR was also associated with a higher complication rate, OR = 1.98 (CI: 1.13-3.46). CONCLUSIONS:: Gallstone ileus is a rare surgical disease affecting mainly the elderly female population. Mortality rates appear to be lower than previously reported in the literature. Enterotomy with stone extraction alone appears to be associated with better outcomes than more invasive techniques.

Original languageEnglish (US)
Pages (from-to)329-335
Number of pages7
JournalAnnals of Surgery
Volume259
Issue number2
DOIs
StatePublished - Feb 1 2014
Externally publishedYes

Fingerprint

Ileus
Gallstones
Fistula
Odds Ratio
Confidence Intervals
Mortality
Multivariate Analysis
Cholecystectomy
Rare Diseases
Hospital Mortality
Acute Kidney Injury
Comorbidity
Inpatients
Length of Stay
Demography
Morbidity
Costs and Cost Analysis
Incidence
Population

Keywords

  • biliary
  • bilioenteric fistula
  • bowel obstruction
  • gallstone ileus

ASJC Scopus subject areas

  • Surgery

Cite this

Halabi, W. J., Kang, C. Y., Ketana, N., Lafaro, K. J., Nguyen, V. Q., Stamos, M. J., ... Demirjian, A. N. (2014). Surgery for gallstone ileus: A nationwide comparison of trends and outcomes. Annals of Surgery, 259(2), 329-335. https://doi.org/10.1097/SLA.0b013e31827eefed

Surgery for gallstone ileus : A nationwide comparison of trends and outcomes. / Halabi, Wissam J; Kang, Celeste Y.; Ketana, Noor; Lafaro, Kelly J.; Nguyen, Vinh Q.; Stamos, Michael J.; Imagawa, David K.; Demirjian, Aram N.

In: Annals of Surgery, Vol. 259, No. 2, 01.02.2014, p. 329-335.

Research output: Contribution to journalArticle

Halabi, WJ, Kang, CY, Ketana, N, Lafaro, KJ, Nguyen, VQ, Stamos, MJ, Imagawa, DK & Demirjian, AN 2014, 'Surgery for gallstone ileus: A nationwide comparison of trends and outcomes', Annals of Surgery, vol. 259, no. 2, pp. 329-335. https://doi.org/10.1097/SLA.0b013e31827eefed
Halabi, Wissam J ; Kang, Celeste Y. ; Ketana, Noor ; Lafaro, Kelly J. ; Nguyen, Vinh Q. ; Stamos, Michael J. ; Imagawa, David K. ; Demirjian, Aram N. / Surgery for gallstone ileus : A nationwide comparison of trends and outcomes. In: Annals of Surgery. 2014 ; Vol. 259, No. 2. pp. 329-335.
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abstract = "INTRODUCTION:: Gallstone ileus is a mechanical bowel obstruction caused by a biliary calculus originating from a bilioenteric fistula. Because of the limited number of reported cases, the optimal surgical method of treatment has been the subject of ongoing debate. METHODS:: A retrospective review of the Nationwide Inpatient Sample from 2004 to 2009 was performed for gallstone ileus cases treated surgically by enterotomy with stone extraction alone (ES), enterotomy and cholecystectomy with fistula closure (EF), bowel resection alone (BR), and bowel resection with fistula closure (BF). Patient demographics, hospital factors, comorbidities, and postoperative outcomes were reported. Multivariate analysis was performed comparing mortality, morbidity, length of stay, and total cost for the different procedure types. RESULTS:: Of the estimated 3,452,536 cases of mechanical bowel obstruction from 2004 to 2009, 3268 (0.095{\%}) were due to gallstone ileus-An incidence lower than previously reported. The majority of patients were elderly women (>70{\%}). ES was the most commonly performed procedure (62{\%} of patients) followed by EF (19{\%} of cases). In 19{\%}, a bowel resection was required. The most common complication was acute renal failure (30.44{\%} of cases). In-hospital mortality was 6.67{\%}. On multivariate analysis, EF and BR were independently associated with higher mortality than ES [(odds ratio [OR] = 2.86; confidence interval [CI]: 1.16-7.07) and (OR = 2.96; CI: 1.26-6.96) respectively]. BR was also associated with a higher complication rate, OR = 1.98 (CI: 1.13-3.46). CONCLUSIONS:: Gallstone ileus is a rare surgical disease affecting mainly the elderly female population. Mortality rates appear to be lower than previously reported in the literature. Enterotomy with stone extraction alone appears to be associated with better outcomes than more invasive techniques.",
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AB - INTRODUCTION:: Gallstone ileus is a mechanical bowel obstruction caused by a biliary calculus originating from a bilioenteric fistula. Because of the limited number of reported cases, the optimal surgical method of treatment has been the subject of ongoing debate. METHODS:: A retrospective review of the Nationwide Inpatient Sample from 2004 to 2009 was performed for gallstone ileus cases treated surgically by enterotomy with stone extraction alone (ES), enterotomy and cholecystectomy with fistula closure (EF), bowel resection alone (BR), and bowel resection with fistula closure (BF). Patient demographics, hospital factors, comorbidities, and postoperative outcomes were reported. Multivariate analysis was performed comparing mortality, morbidity, length of stay, and total cost for the different procedure types. RESULTS:: Of the estimated 3,452,536 cases of mechanical bowel obstruction from 2004 to 2009, 3268 (0.095%) were due to gallstone ileus-An incidence lower than previously reported. The majority of patients were elderly women (>70%). ES was the most commonly performed procedure (62% of patients) followed by EF (19% of cases). In 19%, a bowel resection was required. The most common complication was acute renal failure (30.44% of cases). In-hospital mortality was 6.67%. On multivariate analysis, EF and BR were independently associated with higher mortality than ES [(odds ratio [OR] = 2.86; confidence interval [CI]: 1.16-7.07) and (OR = 2.96; CI: 1.26-6.96) respectively]. BR was also associated with a higher complication rate, OR = 1.98 (CI: 1.13-3.46). CONCLUSIONS:: Gallstone ileus is a rare surgical disease affecting mainly the elderly female population. Mortality rates appear to be lower than previously reported in the literature. Enterotomy with stone extraction alone appears to be associated with better outcomes than more invasive techniques.

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