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[Laparoscopic cholecystectomy in patients previously treated with heart transplantation. A clinical case]
A Cristalli1, M M Visigalli, F Milazzo
1II Servizio Anestesia e Rianimazione, Ospedale Niguarda Ca' Grande, Milano.
Insights
Laparoscopic cholecystectomy is safe and effective in heart transplant recipients. This minimally invasive surgery allows for rapid recovery and early oral intake, even in immunosuppressed patients.
Area of Science:
- Anesthesiology
- Transplant Surgery
Background:
- Cardiac transplant recipients present unique anesthetic challenges due to denervated hearts and immunosuppression.
- Cholelithiasis necessitates surgical intervention, with laparoscopic cholecystectomy being a preferred minimally invasive option.
Observation:
- A 46-year-old patient with a history of cardiac transplantation underwent laparoscopic cholecystectomy.
- Careful monitoring of vital parameters, particularly capnometry to manage partial pressure of carbon dioxide (paCO2), was crucial.
- The patient's immunosuppressed status required balancing invasive monitoring with minimizing surgical invasivity.
Findings:
- Laparoscopic cholecystectomy proceeded without complications in this denervated heart patient.
- Effective management of paCO2 using capnometry prevented hypercapnia.
- The patient experienced a rapid recovery, tolerating food and oral immunosuppressants within 24 hours.
Implications:
- Laparoscopic cholecystectomy is a viable and safe surgical approach for patients with cardiac transplants.
- Minimally invasive techniques and vigilant monitoring, including capnometry, are key to successful outcomes in this population.
- Early recovery and discharge are achievable, improving patient experience and reducing hospital stay for immunosuppressed individuals.
Abstract:
A 46-years old patient who had already undergone cardiac transplantation was scheduled for laparoscopic cholecystectomy following a diagnosis of cholelithiasis. In this particular case we were not faced with any problems even in presence of a denervated heart. Since the patient was immnosuppressed, we had to look for the best compromise between the need of monitoring closely the most important vital parameters and contemporarily reducing invasivity as much as possible. Capnometry was of paramount importance, enabling us to prevent and to correct high paCO2 values. The rapid recovery of the patient allowed us to begin with food intake and oral immunosuppressive therapy already 24 hours after the operation and to discharge the patient on the third day after surgery. Laparoscopic cholecystectomy represented a successful choice and a satisfying procedure both for the anaesthesiologist and for the patient, particularly regarding the minimal invasivity and the rapid recovery, which were considered of great importance in the immunodepressed patient.