CHOLECYSTECTOMY - WHICH PROCEDURE IS BEST FOR THE HIGH-RISK PATIENT

Laparoscopic cholecystectomy (LC), which results in less postoperative pain, disability, and scarring, has become an attractive alternative method of surgical management of the ambulatory patient with gallbladd er disease. The best procedure for severely ill patients who are poor operative risks but require cholecystectomy, however, is unknown since the operative morbidity and mortality of LC in this group of patients has not been studied. All patients (177) undergoing cholecystectomy a t one institution were evaluated. Based on their preoperative state of health as defined by a modified acute physiologic score (APS), patien ts were divided into two groups; one group was defined by an APS of le ss than 10, indicating they were in good health, and the other had an APS greater than or equal to 10, indicating that the group had multipl e risk factors, predicting an increased postoperative morbidity and mo rtality. Selection for either procedure, LC or open cholecystectomy (O C), was made independently of the patient's preoperative status. Patie nts' past medical histories; demographic, physiologic, and laboratory data; and postoperative complications were evaluated. When all cholecy stectomy patients were arranged into the respective risk groups, the a ge and severity of illness scores (APS) between LC and OC were not sta tistically different. Intraoperative and postoperative complications w ere not significantly different when patients undergoing LC were compa red to patients undergoing OC.-Laparoscopic cholecystectomy was associ ated with decreased hospitalization when compared to patients undergoi ng OC. The overall mortality of the patients undergoing OC was signifi cantly greater than those undergoing LC. LC is an acceptable surgical alternative for high-risk patients requiring cholecystectomy.