LAPAROSCOPIC CHOLECYSTECTOMY IN TRANSPLANT PATIENTS

Acute cholecystitis is a serious condition in transplant patients and elective cholecystectomy is generally recommended when gallstones are found. We reviewed the results of laparoscopic cholecystectomy (LC) in 10 immunosuppressed transplant patients (6 heart, 4 kidney) and compa red them to the results of open cholecystectomy performed in 26 transp lant patients (14 heart, 11 kidney, 1 kidney/pancreas). The LC group h ad a 20% incidence of minor complication with no major complications a nd no deaths. The open-cholecystectomy group experienced 19% minor com plications, 23% major complications, and 15% deaths. The average posto perative length of stay for the LC patients was 4.6 days (2 days for t he 5 straight forward cases) as compared to 9.1 days after open cholec ystectomy (4 days for the 13 straightforward open cases). Oral immunos uppression was stopped prior to operation but could be restarted withi n 29 hours after operation in the LC patients and 68 h in the open cas es. The findings at LC were helpful in assessing whether acute cholecy stitis and/or choledocholithiasis was The source of fever, liver-funct ion abnormalities, or pancreatitis in these immunosuppressed transplan t patients. We conclude that LC can be performed safely in transplant patients, but that in 10-20% of patients, the operation will be conver ted to an open procedure. The advantages of LC in these patients are a shorter hospitalization and less delay to resumption of preoperative oral immunotherapy than after open cholecystectomy.