[Laparoscopic cholecystectomy in high risk patients]

Of approximately 600 laparoscopic cholecystectomies performed between October 1991-April 1994, 21 were in patients categorized as "high operative risks." The indications for operation were: symptomatic gallstones, 9 patients, state after acute cholecystitis treated medically (8), state after acute cholecystitis treated by cholecystostomy (3), and 1 patient with acute cholecystitis unresponsive to medical treatment. Operative risk according to ASA grading was II-III in 7 patients, III in 10, III-IV in 2 and IV in 2 (group average ASA III). They were prepared for operation by optimizing their various medical conditions. 4 with severe cardiac disease (ASA III-IV and IV) underwent laparoscopic cholecystectomy with close monitoring of hemodynamic status via radial artery and pulmonary artery catheters. Following surgery, they were monitored in the surgical intensive care unit for 12-24 hours. There were no complications during or following operation. The mean postoperative stay in hospital was 1.9 days (range 1-3). All patients were able to return to their preoperative life styles and activities. High operative risk is not a contraindication to laparoscopic cholecystectomy.