Gh Hussain Mir, Muneer A Wani, Talib Khan, Ajaz A Malik, Sajad A Bhat and Tariq A Mir

Laparoscopic cholecystectomy (LC) has emerged as new gold standard for treatment of symptomatic cholelithiasis and increasing number of procedures are done for patients with various high risk comorbid conditions. In recent years development of surgical skills and better understanding of pathophysiology of pneumoperitoneum have made it possible to offer LC to patients suffering from various high risks. However by virtue of its positive pressure pneumoperitoneum and carbon dioxide (CO2) insufflations, LC poses some deleterious effects on cardiopulmonary system. For high risk patient’s preoperative preparation, active perioperative monitoring and low pressure pneumoperitoneum with intraoperative and postoperative complications were studied. In this prospective and retrospective hospital based observational study, we included 134 patients that underwent LC and laparoscopy converted to open cholecystectomy from May 2012- May 2016. Mean age was 61.5years, with male to female ratio of 5:11. The majority of our high risk patients (77.6%) had cardiac ailments including conduction disturbances, arrythmias, valvular heart disease, coronary artery disease, myocardial infarction and congenital heart diseases. Out of these, 4.4% patients had ejection fraction less than 30-40%. Respiratory comorbiditiescomplicated about 11.9% patients.Conversion rate to open cholecystectomy in our study was about 8.9%. Postoperative complications were reported in 16.4% of patients. Patients were grouped as per American Society of Anaesthesiologists (ASA) grading. We concluded that in presence ofthorough preoperative assessment and optimization, intraoperative balanced anaesthesia, low pressure pneumoperitoneum and postoperative care, laparoscopic cholecystectomy is safe for high risk patients.

Download PDF: