Cholelithiasis and aortic reconstruction: the problem of simultaneous surgical therapy. Conclusions from a personal...

From 1976 to 1983, 682 patients have undergone aortic reconstruction at Parkland Memorial Hospital and the Veterans Administration Hospital in Dallas, Texas. Thirty-five patients (5.1%) had a biliary tract operation performed before, during, or after their aortic procedure. Fourteen percent of patients had bacteria in the bile and 11.4% needed common bile duct exploration. Twelve patients had their aortic reconstruction first. Biliary pancreatitis developed postoperatively in one patient. Two patients who had infected prostheses removed had acalculous cholecystitis after operation and one had jaundice and fever 3 years after operation, but no biliary disease was found. Twenty-one patients had the biliary procedure first. Four patients were operated on for suspected aneurysm rupture an average of 18 months after operation. There was one true rupture; this patient had no gallstones. One patient had acute aortic thrombosis 10 days after emergency operation for acute cholecystitis. Only two patients underwent combined operative procedures; both were patients with acute aortic problems in whom chronic and subacute biliary disease was found. Eight operative deaths occurred, all in the patients undergoing aortic procedures. There were no ruptured aneurysms or acute biliary problems needing emergency operation in any patient with cholelithiasis. On the basis of our experience, we believe that concomitant cholecystectomy and aortic reconstructions rarely need to be performed and then only in those patients in whom the risk of not treating both biliary and aortic conditions is greater than the operative risks. In these circumstances, cholecystostomy should be considered to decrease operative time and the risk of graft contamination.