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Laparoscopic cholecystectomy using the abdominal wall lift in a cardiac patient
T Matsumoto1, S Kitano, T Yoshida
1Department of Surgery I, Oita Medical University, Japan.
Insights
This case report details a laparoscopic cholecystectomy using abdominal wall lift in a patient with impaired cardiac function. The technique maintained stable cardiac output, demonstrating a safe approach for gallbladder removal in high-risk cardiac patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Aortic valve replacement and mitral commissurotomy can lead to impaired cardiac function.
- Cholelithiasis necessitates surgical intervention, posing risks for cardiac patients.
- Pneumoperitoneum in laparoscopic surgery can reduce cardiac output.
Observation:
- A patient with pre-existing cardiac compromise underwent laparoscopic cholecystectomy.
- The abdominal wall lift technique was employed to mitigate hemodynamic compromise.
- Transesophageal echocardiography monitored cardiac function throughout the procedure.
Findings:
- Cardiac function remained stable during the laparoscopic procedure using abdominal wall lift.
- Perioperative anticoagulation management was crucial due to atrial fibrillation and a prosthetic valve.
- The patient experienced an uneventful recovery and was discharged on postoperative day 7.
Implications:
- Laparoscopic cholecystectomy with abdominal wall lift is a viable option for patients with impaired cardiac function.
- Careful perioperative management, including anticoagulation, is essential for high-risk surgical candidates.
- This approach may reduce the risks associated with traditional pneumoperitoneum in cardiac patients.
Abstract:
We present a case report of a patient with impaired cardiac function after aortic valve replacement and open mitral commissurotomy who underwent a laparoscopic cholecystectomy for cholecystolithiasis. In preventing reduced cardiac output due to pneumoperitoneum, the laparoscopic operative procedure was performed using the abdominal wall lift. Cardiac function was continuously evaluated by transesophageal echocardiographic examination and remained stable during the surgery. Because of the patient's co-existing chronic atrial fibrillation and prosthetic aortic valve, perioperative anticoagulation management was carried out. The patient's post-operative course was uneventful, and he was discharged on the 7th post-operative day.