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[Combined coronary artery bypass grafting and choledocholithotomy--a report of two cases]
1Department of Cardiovascular Surgery, Kantou Teishin Hospital, Tokyo, Japan.
Insights
This study shows combined coronary artery bypass grafting and choledocholithotomy surgery is effective for patients with both ischemic heart disease and gallstones. Performing bypass surgery first helps prevent complications from the gallstone procedure.
Area of Science:
- Cardiology
- Hepatobiliary Surgery
- Surgical Innovation
Background:
- Patients with ischemic heart disease and choledocholithiasis present a complex surgical challenge.
- Concurrent management requires careful consideration of procedural order and potential complications.
- Existing literature lacks extensive data on combined surgical approaches.
Observation:
- Two patients (74-year-old male, 66-year-old female) diagnosed with angina pectoris and choledocholithiasis underwent combined procedures.
- Coronary artery bypass grafting (CABG) was performed before choledocholithotomy to mitigate cardiac and mediastinal infection risks.
- A single skin incision was utilized in the patient with biliary tract infection for graft preparation.
Findings:
- Successful combined CABG and choledocholithotomy was achieved in both cases.
- Preemptive CABG effectively prevented cardiac complications and mediastinal infection.
- The single-incision approach in the infected case demonstrated feasibility.
Implications:
- Combined surgical intervention is a viable option for select patients with coexisting ischemic heart disease and choledocholithiasis.
- Strategic sequencing of procedures (CABG first) optimizes patient safety.
- Further research into single-incision techniques for combined procedures may enhance surgical efficiency.
Abstract:
A 74-year-old man and a 66-year-old woman were diagnosed as angina pectoris with choledocholithiasis. Combined coronary artery bypass grafting and choledocholithotomy were performed successfully in the two cases. For the prevention of cardiac complications and mediastinal infection, coronary artery bypass grafting was performed prior to choledocholithotomy. However, skin incisions were different in both cases. In the case with the biliary tract infection, both two surgical procedure were performed through a single skin incision in order to prepare the gastroepiploic artery as a graft. The combined operation is considered to be useful in selected cases with ischemic heart disease and choledocholithiasis.