Laparoscopic Management of Biliary Fistulas

Biliary fistulas, abnormal communications between the biliary system and the gastrointestinal tract, represent a challenging complication of gallstone disease, inflammation or malignancy. Traditionally managed by open surgery, these lesions are increasingly approached by laparoscopy, which offers reduced postoperative pain, shorter hospital stay and faster return to normal activity. Preoperative imaging with high-resolution CT, MRI and endoscopic retrograde cholangiopancreatography has improved detection, yet many fistulas remain an intraoperative surprise. Laparoscopic strategies centre on meticulous dissection of dense adhesions, identification of the fistulous tract, and secure closure of biliary and enteric defects, often using intracorporeal sutures or clips. Subtypes such as cholecystoduodenal and cholecystocolonic fistulas demand tailored manoeuvres owing to their proximity to vital structures. The advent of robotic-assisted platforms enhances dexterity and three-dimensional visualisation in complex dissections, expanding the indications for minimally invasive repair. Global experience demonstrates low morbidity and high success rates when performed by surgeons with advanced laparoscopic expertise, underscoring the importance of training, patient selection and resource adaptation in diverse healthcare settings.

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Laparoscopic Management of Biliary Fistulas publication trend

The graph below shows the total number of articles in laparoscopic management of biliary fistulas across all publications each year (not limited to Nature Index journals).

Technical terms

Cholecystoenteric fistula: An abnormal passage between the gallbladder and any segment of the gastrointestinal tract.

Laparoscopy: Minimally invasive surgery performed through small abdominal incisions using a camera and specialised instruments.

Cholecystoduodenal fistula: A communication specifically between the gallbladder and the duodenum.

Cholecystocolonic fistula: A connection between the gallbladder and the colon.

Endoscopic retrograde cholangiopancreatography: An endoscopic and radiological technique to visualise and intervene in the biliary and pancreatic ducts.

Pneumobilia: Presence of air within the biliary tree, often indicating a fistulous connection.

Robotic-assisted surgery: A form of laparoscopy employing robotic systems to enhance precision, dexterity and three-dimensional vision.

References

1. Laparoscopic management of cholecystocolonic fistula: A case report and a brief literature review. International Journal of Surgery Case Reports (2020).
2. Robotic-Assisted Cholecystoduodenal Fistula and Bile Leak Repair. Cureus (2024).
3. Robotic Diagnosis and Management of Acute Cholecystocolonic Fistula. Cureus (2022).