P. Kent et al., LAPAROSCOPIC CHOLECYSTECTOMY IN CARDIAC TRANSPLANT PATIENTS - LOWER THRESHOLD FOR SURGERY, Minimally invasive therapy, 2(4), 1993, pp. 181-183
Laparoscopic cholecystectomy is accepted by the surgical community as
an advance in the definitive treatment of gallstones. In this paper we
describe five patients post-cardiac transplantation, in whom laparosc
opic cholecystectomy was undertaken. One patient, who had two previous
laparotomies, required conversion to an open cholecystectomy. In each
case the gallstones were symptomatic and were a major cause of morbid
ity. The average hospital stay was 4 days in uncomplicated cases, but
was prolonged in one patient who required stabilization of cyclosporin
levels (7 days) and in one patient due to a sub-hepatic collection (1
7 days). This was successfully treated by percutaneous ultrasound guid
ed drainage. The technical problems of laparoscopic cholecystectomy ar
e no different in transplant patients but it may have the advantage of
being less immunotraumatic and allow earlier mobilization. Laparoscop
ic cholecystectomy is an advance in the treatment of gallstones and be
cause of the risks of acute cholecystitis in cardiac transplant patien
ts, should lower the threshold to definitive surgery.