[A rational approach to cholecystectomy in the patient with an abdominal aortic aneurysm]

A retrospective series of 30 (2.8%) cases of cholelithiasis out of 1064 abdominal aortic aneurysmectomies is presented. 21 subjects underwent aneurysmectomy and prosthetic grafting combined with cholecystectomy. Complications related to the combined operation, early or late (6 months to 8 years follow-up was available for the whole series), were not recorded in this subgroup. 9 (30%) patients with coincidental gallstones underwent simple aneurysmectomy: 2 (22%) patients complained of symptoms of biliary colic, eight and fifteen weeks after operation respectively, and successfully underwent medical treatment. A third patient (11%), operated on urgently for ruptured abdominal aortic aneurysm, developed acute cholecystitis, gallbladder perforation and biliary peritonitis on the 17th day of operation: he died of multiple organs failure on the 8th day of urgent cholecystectomy. Acute alithiasic cholecystitis was recorded only once (0.1%) among the 1034 abdominal aortic aneurysmectomies without gallstones: fatal outcome was ascribed to massive multiple organ cholesterol embolization. If careful asepsis and correct surgical tactics are observed, cholecystectomy can safely be performed in combination with abdominal aortic aneurysmectomy in subjects with a positive history of cholecystitis or in poor general conditions, but it cannot be considered as a prophylactic treatment towards postoperative acute cholecystitis in good-risk subjects with a negative history of cholecystitis.