Changing concepts in the surgical treatment of gallstone ileus: a review of 15 cases with emphasis on diagnosis and treatment.

THME treatment of and results in patients with gallstone ileus have been recently reviewed.1-3',7 Formerly, surgical treatment consisted of removing the obstructing stone by enterotomy and exploring the remaining intestine for additional stones. Followup studies on these patients show an increasing morbidity attributed to the diseased gallbladder or to the patent biliary fistula. Conversely, there has been a continuing decrease in the surgical mortality, from 27% in 1960 to less than 15%o at present."'13' 23 These factors have led surgeons to reappraise the treatment of gallstone ileus. Some now favor a more aggressive and complete repair consisting of enterotomy, cholecystectomy, and closure of the fistula.