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Acute cholecystitis and severe ischemic cardiac disease: is laparoscopy indicated?
Jihad R Salameh1, Morris E Franklin
1Texas Endosurgery Institute, San Antonio, Texas 78222, USA.
Insights
Laparoscopic surgery for gallstones is safe in patients with severe heart disease. Careful monitoring and low-pressure pneumoperitoneum allow for successful laparoscopic cholecystectomy and common bile duct exploration.
Area of Science:
- Minimally Invasive Surgery
- Cardiology
- Gastroenterology
Background:
- Laparoscopic cholecystectomy is controversial in patients with poor cardiac function.
- Severe coronary artery disease poses a relative contraindication for laparoscopic procedures.
Observation:
- A case of acute cholecystitis and choledocholithiasis with unstable angina was managed.
- Laparoscopic cholecystectomy and common bile duct exploration were performed after coronary angioplasty and stenting.
Findings:
- 39 patients with coronary artery disease (ASA III-IV) underwent laparoscopic cholecystectomy.
- Eight patients (20.5%) required laparoscopic common bile duct exploration for stones.
- No conversions or major morbidity/mortality occurred in the study group.
Implications:
- Laparoscopic cholecystectomy and common bile duct exploration are safe in severe ischemic heart disease.
- Close hemodynamic monitoring and low-pressure pneumoperitoneum (10-12 mm Hg) are crucial for patient safety.
Background And Objectives:
Laparoscopy in patients with poor cardiac function has been the subject of controversy and is considered by many surgeons a relative contraindication.
Methods:
We report the case of a patient who presented with acute cholecystitis and choledocholithiasis concurrent with unstable angina. Our experience in laparoscopic management of patients with calculous biliary disease and severe coronary artery disease is examined.
Results:
The patient was managed by coronary angioplasty and stenting immediately followed by laparoscopic cholecystectomy and common bile duct exploration under close invasive hemodynamic monitoring and low-pressure pneumoperitoneum. Between 1996 and 2001, 39 patients with coronary artery disease and an ASA class of III or IV underwent laparoscopic cholecystectomy. Eight of these patients (20.5%) had common bile duct stones necessitating laparoscopic common bile duct exploration. No conversions were necessary, and no major morbidity or mortalities occurred.
Conclusions:
Laparoscopic cholecystectomy and common bile duct exploration can be safely performed in patients with severe ischemic cardiac disease under close hemodynamic monitoring and a low-pressure pneumoperitoneum (10 to 12 mm Hg).
