# Surgical treatment of Bouveret Syndrome without completion cholecystectomy

## TL;DR

This paper reports two cases where Bouveret Syndrome was successfully treated with gallstone removal alone, without additional surgery, and both patients remained symptom-free for two years.

## Contribution

The paper challenges the standard two-stage surgical approach by presenting successful outcomes with a simplified single-stage treatment.

## Key findings

- Two patients with Bouveret Syndrome were treated with gallstone removal alone.
- Both patients remained symptom-free for two years post-surgery without needing further procedures.
- The findings suggest that routine cholecystectomy and fistula repair may not always be necessary.

## Abstract

Bouveret syndrome, the rarest variant of gallstone ileus, occurs due to the passage of a gallstone into the gastrointestinal tract via a bilioenteric fistula, leading to gastric outlet obstruction. This condition represents less than 0.1 % of all mechanical bowel obstructions, predominantly affecting elderly females. Its nonspecific symptoms, including nausea, vomiting, and abdominal pain, often result in delayed diagnosis and significant mortality rates ranging from 12 % to 30 %. Historically, management involves a two-stage surgical approach: initial stone removal followed by interval cholecystectomy and fistula repair to prevent recurrence.

This report presents two cases of younger patients with Bouveret syndrome managed with a single-stage surgical approach consisting of gallstone removal without subsequent cholecystectomy or fistula repair. Both patients remained symptom-free for two years postoperatively.

These findings challenge the necessity of routine interval cholecystectomy and fistula closure, particularly in patients without recurrent biliary symptoms. We discuss the implications of a simplified surgical strategy, highlighting the potential for spontaneous fistula closure or adaptation of bile drainage pathways.

While current literature supports interval surgery for younger patients to mitigate long-term risks, these cases suggest that selective management may reduce morbidity without compromising outcomes. Further research is needed to refine guidelines for the surgical management of Bouveret syndrome.

•Two patients with Bouveret Syndrome were treated with gallstone removal•Neither patient had a fistula closure or cholecystectomy•Two years post-operatively, both patients are doing well without recurrent symptoms•Fistula closure and cholecystectomy have been described as the standard of care•These two patients are evidence that may not be required

Two patients with Bouveret Syndrome were treated with gallstone removal

Neither patient had a fistula closure or cholecystectomy

Two years post-operatively, both patients are doing well without recurrent symptoms

Fistula closure and cholecystectomy have been described as the standard of care

These two patients are evidence that may not be required