EBM Consult

Enterolithotomy With or Without Concurrent Cholecystectomy for Gallstone Ileus

The current evidence suggests that enterolithotomy without concurrent cholecystectomy is still the standard of practice for most cases of gallstone ileus.  Patients who are young and considered low-risk may more likely tolerate both an enterolithotomy and cholecystectomy. 

  • There is no known mortality benefit in patients concurrently getting cholecystectomy
  • Patients getting both an enterolithotomy and cholecystectomy appear to result in prolonged hospital stays and more minor postoperative complications.

Contributor & Content Editor:  Sean C. Dupont, MD
Editor-in-Chief: Anthony J. Busti, MD, PharmD, MSc, FNLA, FAHA

Supporting Guidelines

  • We are not aware of any, but please contact us if you do.

Landmark or Original Studies

  • Mallipeddi, M., et al. Gallstone ileus: revisiting surgical outcomes using national surgical quality improvement program data. J Surg Res 2013;184(1):84-88. PubMed
    Study Design Descriptive analysis using the ACS-NSQIP database
    Sample Size n = 127
    • n = 127; surgical procedure to relieve mechanical bowel obstruction.
    • n = 14; cholecystectomy in addition to surgical procedure to relieve mechanical bowel obstruction
    Follow Up 30 days
    Primary Endpoint Review the outcomes of patients undergoing surgical management of mechanical bowel obstruction secondary to gallstone ileus.
    Secondary Endpoint Determine if concurrent cholecystectomy during surgical management of gallstone ileus increased morbidity or mortality rates.  
    • In patients undergoing surgical management of gallstone ileus, the 30-day mortality rate 5.5% and the morbidity rate was 35.4%.
    • No significant difference in mortality rate between no cholecystectomy and the cholecystectomy groups (5.3% vs. 7.1%, respectively; p = 0.78), but patients receiving a cholecystectomy were more likely to sustain minor postoperative complications and longer hospitalizations.
    Conclusions Surgical management of gallstone ileus in the modern era is generally less morbid than would be predicted by published historical experience and there is still not enough evidence to favor concurrent cholecystectomy.
    Location >250 hospitals participating in the ACS-NSQIP database
    Comments While the ACS-NSQIP database allows access to a large number of patients with reliable information, the small sample size of cholecystectomy group prohibits definitive conclusions and increases the chance for a type II error.