Cholecysto-duodenal and cholecysto-colic fistulae identified intraoperatively during laparoscopic cholecystectomy in a surgical hub.

Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstone disease and is often performed in elective settings. To address surgical backlogs, the United Kingdom has adopted off-site elective surgical hubs designed for high-volume, low-complexity procedures. We describe a case of a young woman undergoing laparoscopic cholecystectomy at a surgical hub, in whom two cholecysto-enteric fistulae - cholecysto-duodenal and cholecysto-colic - were unexpectedly identified intraoperatively. Both were successfully managed laparoscopically. This rare intraoperative finding, in a low-risk, preoperatively uncomplicated case highlights the importance of surgical vigilance and reinforces the need for surgical hubs to be equipped with appropriate expertise, instruments, and escalation pathways to manage unanticipated intraoperative complexity.