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Laparoscopic cholecystectomy in patients with cardiac dysfunction
Sagar Sadhu1, Sujit Sarkar, Tarshid A Jahangir
1Department of Surgery and MIS, Rabindranath Tagore International Institute of Cardiac Sciences, 124 Mukundapur, Kolkata, 700099 India.
Insights
Laparoscopic cholecystectomy is safe for patients with cardiac issues. With expert cardiac support, this gallbladder surgery can be performed effectively, even in high-risk individuals.
Area of Science:
- Cardiovascular Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy is the standard for gallstones.
- Increasingly, patients with complex medical conditions undergo this procedure.
- Concerns exist regarding the safety of laparoscopic cholecystectomy in patients with cardiac comorbidities.
Purpose of the Study:
- To evaluate the safety and outcomes of laparoscopic cholecystectomy in patients with significant cardiac dysfunction.
- To assess peri-operative management and postoperative complications in this high-risk group.
Main Methods:
- Prospective evaluation of 28 patients with cardiac dysfunction undergoing laparoscopic cholecystectomy.
- Pre-operative assessment by cardiologists and anesthesiologists.
- Detailed recording of peri-operative management and postoperative complications.
Main Results:
- 28 patients (mean age 60) with significant cardiac dysfunction (NYHA class II/III, low ejection fraction) underwent the procedure.
- Common events included hypertension, tachyarrhythmia, and bradycardia.
- One patient required conversion to laparotomy and died from myocardial infarction; others recovered well.
Conclusions:
- Laparoscopic cholecystectomy can be safely performed in patients with significant cardiac dysfunction.
- Appropriate cardiological support is crucial for successful outcomes.
- This minimally invasive approach offers a viable option for selected high-risk patients.
Abstract:
Laparoscopic cholecystectomy remains the standard treatment for cholelithiasis. Ever increasing number of patients with myriad of medical illness is being treated by this technique. However, significant concern prevails among the surgical community regarding its safety in patients with cardiac co-morbidity. Patients with significant cardiac dysfunction and multiple co-morbidities were prospectively evaluated. Patients were assessed by cardiologists and anesthesiologists and laparoscopic cholecystectomy was performed. Patient demographics, details of peri-operative management and post-operative complications were studied. Between March 2005 and January 2009, 28 patients (M:F = 21:7) with mean age of 60 years (range 26-78) and having significant cardiac dysfunction had undergone laparoscopic cholecystectomy. Of these, 24 patients were in NYHA class-II, while 4 belonged to class-III. Left ventricular ejection fraction, as recorded by transthoracic echocardiography, was 20-30% in 13 (46%) patients and 30-40% in the rest 15 (54%). In addition, 13 (46%) patients had regional wall motion abnormalities, 11 (39%) patients had cardiomyopathy, 2 (7%) patients had valvular heart disease while 12 (43%) patients had prior cardiac interventions. Following laparoscopic cholecystectomy, hypertension (3), tachyarrhythmia (4) and bradycardia (1) were the commonest events encountered. One patient required laparotomy to deal with peritonitis in the immediate postoperative period and succumbed to myocardial infarction, but all other patients made an uneventful recovery. With appropriate cardiological support, laparoscopic cholecystectomy may be safely performed in patients with significant cardiac dysfunction.
