LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS UNDERGOING ANTICOAGULANT-THERAPY

We recently performed a laparoscopic cholecystectomy on three patients receiving preoperative oral anticoagulant therapy. The patients requi ring anticoagulants for pre-existing cardiac conditions have the follo wing risks at surgery: thromboembolism, hemorrhage, endocarditis, and cardiopulmonary dysfunction. In patients receiving anticoagulant thera py, one must thus maintain a balanced international normalized ratio o f the prothrombin time to prevent thromboembolism or hemorrhage. Warfa rin sodium was discontinued preoperatively in all patients. Heparin so dium was individualized according to each patient's risk of thromboemb olism. As a result, these patients all underwent a laparoscopic cholec ystectomy without complications. Attention was paid to achieve hemosta sis in the operative field and the trocar inserted sites during the pr ocedure. The administration of warfarin sodium was resumed on the firs t postoperative day in all patients. Restarting warfarin sodium early also helps to simplify postoperative management. A broad spectrum of a ntibiotic therapy was also used to reduce the risk of endocarditis. Ea ch patient's cardiopulmonary function was carefully monitored. The min imal invasion experienced during a laparoscopic cholecystectomy may th us facilitate the management of gallstones in patients receiving syste mic anticoagulation treatment based on the findings of this limited se ries.