Management of cholelithiasis in combination with cardiovascular surgery

A retrospective review of the perioperative management of patients with car diovascular surgical disorders and cholelithiasis was conducted, and the su rgical strategies employed are discussed. Between 1988 and 1998, 18 patient s having cardiovascular surgical disorders underwent cholecystectomy. These patients were divided into three groups: group I, given a one-stage operat ion (n = 9); group II, given a two-stage operation (n = 3); and group III, given cholecystectomy during follow-up after cardiovascular surgery (n = 6) . In group I, a median laparotomy was adopted for patients with an abdomina l aortic aneurysm (AAA) to allow both disorders to be treated through the s ame incision, whereas a right subcostal approach was employed to separate t he incisions for patients who underwent cardiac operations. In group II, on e patient underwent cholecystectomy before cardiac surgery, and two patient s underwent cholecystectomy for postoperative cholecystitis after cardiovas cular operations. One patient from group II;Ind all from group III were on preoperative anticoagulant therapy, two of whom underwent laparoscopic chol ecystectomy. No fatal complications such as prosthetic infection, intraperi toneal hemorrhage, or cerebral attack were encountered. In conclusion, we c onsider that performing cholecystectomy during AAA repair may be safe and p revents the risk of postoperative cholecystitis; it is preferable to treat cholelithiasis coexisting with cardiac disorders concomitantly with or befo re cardiac operations; and laparoscopic cholecystectomy can be safely perfo rmed under anticoagulant therapy.