Cholecystectomy during abdominal aortic aneurysm repair in patients with gallstones

Background: Simultaneous cholecystectomy for asymptomatic cholelithiasis du ring abdominal aortic aneurysm (AAA) repair is not widely accepted. We revi ewed our data to determine morbidity and mortality in patients with choleli thiasis undergoing AAA repair. Methods: Over the past 5 years, 320 infrarenal AAA repairs were done in our institution. Twenty-nine patients were identified as having had a prior ch olecystectomy, leaving 291 patients in the study group. Forty-seven patient s (16%) were found to have cholelithiasis. Thirty patients underwent a chol ecystectomy at the time of the AAA repair (GpA), whereas 17 patients did no t have their gallbladder removed (GpB). Patient characteristics, postoperat ive complications, and mortality were compared. Results: Two patients in GpA died (6.7%), one of renal failure and the othe r of respiratory failure. In GpB there were three deaths (17.6%) due to pos toperative hemorrhage. No deaths in either group were related to the biliar y tract. Ten infectious complications occurred in six patients in GpB (35%) , compared with only 10% of patients in GpA (p<0.05). Cholecystitis occurre d in 24% of patients in GpB, with no cases in GpA (p<0.02). Complications d irectly related to the biliary tract occurred in 35% of patients in GpB (p< 0.02). Conclusions: These data indicate that asymptomatic gallstones resulted in s ignificant morbidity during the postoperative recovery period from AAA repa ir. We conclude that patients with asymptomatic gallstones should undergo r outine cholecystectomy at the time of the AAA repair.