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Biliary surgery after heart transplantation
F Menegaux1, R Dorent, D Tabbi
1Department of General and Gastrointestinal Surgery, Hôpital de la Pitié, Paris, France.
Insights
Biliary tract disease is common in heart transplant recipients. Laparoscopic cholecystectomy is a safe and effective treatment for gallstones in these patients, even if they are asymptomatic.
Area of Science:
- Transplant Surgery
- Gastroenterology
- Hepatology
Background:
- Biliary tract diseases are prevalent in heart transplant recipients, contributing to significant morbidity and mortality.
- Gallstones often present acutely as cholecystitis in this population, indicating asymptomatic cholelithiasis is not benign.
- Early recognition and management of biliary pathology are crucial for post-transplant outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of cholecystectomy in heart transplant recipients.
- To determine the optimal surgical approach for gallstone management in this unique patient group.
- To assess the outcomes of laparoscopic versus open cholecystectomy in post-heart transplant patients.
Main Methods:
- Retrospective review of 18 heart transplant recipients who underwent cholecystectomy between January 1991 and June 1997.
- Analysis of surgical procedures, including open and laparoscopic cholecystectomy.
- Comparison of outcomes based on surgical approach and symptomatic status of cholelithiasis.
Main Results:
- Laparoscopic cholecystectomy was performed in 15 patients without conversion to open surgery.
- Open cholecystectomy was chosen for 3 patients with suspected acute cholecystitis.
- No significant complications were reported in any of the patients undergoing cholecystectomy.
Conclusions:
- Heart transplant recipients with cholelithiasis should undergo laparoscopic cholecystectomy during their post-transplant course.
- The symptomatic status of biliary tract disease should not preclude surgical intervention.
- Laparoscopic cholecystectomy is a safe and effective option for managing gallstones in heart transplant recipients.
Background:
Biliary tract diseases are frequent in heart transplant recipients, with significant morbidity and mortality. Since the first presentation of gallstones in this population is often acute cholecystitis, asymptomatic cholelithiasis should not be considered benign.
Patients And Methods:
We retrospectively reviewed 18 heart transplant recipients who underwent cholecystectomy from January 1991 to June 1997. We intentionally chose to perform a straightforward open procedure when acute cholecystitis was suspected (3 patients). A laparoscopic cholecystectomy was performed in all the other cases (15 patients) without conversion to open procedure.
Conclusion:
Since no significant complications were observed in our patients, we believe that transplant recipients with cholelithiasis should undergo laparoscopic cholecystectomy in their posttransplantation course regardless of the symptomatic status of their biliary tract.