[Laparoscopic cholecystectomy in high risk patients]

As opposed to the advantages of laparoscopic cholecystectomy, patients with cardiopulmonary impairment may be endangered by the haemodynamic and respiratory effects of the pneumoperitoneum. Between June 1990 and December 1995, laparoscopic cholecystectomies were performed in 19 high-risk patients (ASA IV) and 465 patients with a lower operative risk (ASA I-III). Out of 484 patients, 24 (5%) suffered intraoperative cardiopulmonary complications. Three belonged to the high-risk group (15.8%) and 21 to the lower risk groups (4.5%). General postoperative complications occurred in 14 cases (2.9%), whereby patients of the ASA IV group were, again, concerned more often [15.8% (n = 3) of ASA IV versus 2.4% (n = 11) of ASA I-III]. The number of days spent in hospital was 7.6 +/- 4.96 days in the high-risk group versus 4.8 +/- 2.23 days in groups ASA I-III. The evaluation as a high-risk patient indicates an elevation of the perioperative rate of complications in laparoscopic cholecystectomy; however, it is not basically a contraindication for this operative method.