Clinical Outcomes of Synchronous Laparoscopic Cholecystectomy with Coronary Artery Revascularization
Uyar, Ihsan Sami
Karaca, Ibrahim Sami
Dogan, Omer Faruk
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Background: There are limited data about the results of simultaneous coronary revascularization, either with coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI), and cholecystectomy operations. Here we present clinical outcomes of the patients who underwent simultaneous laparoscopic cholecystectomy (LC) and coronary revascularization at the same session. Patients and Methods: We included a total of 19 patients who underwent simultaneous LC and CABG or PCI. Thirteen of them had been hospitalized because of acute cholecystitis prior to coronary angiography. Simultaneous CABG and LC were performed in 10 patients (group I). LC was performed immediately after CABG surgery at the same session. PCI (group II) was performed in 9 patients. In the PCI group, LC was performed under general anesthesia 2 or 3 days after PCI. Results: No mortality was seen after the procedures. In the CABG group, the mean number of bypass grafts was 3.4 +/- 1.9. The mean extracorporeal circulation and the total operation times were 95 +/- 13.5 minutes and 259 +/- 18.9 minutes, respectively; the mean intubation duration was 17 +/- 4.8 hours. In the PCI group, the mean number of stents per patient was 2.1 +/- 0.7; LC was performed 2 or 3 days after the PCI without the cessation of clopidogrel and acetylsalicylic acid. The mean operation times for LC were 56.5 +/- 15.6 minutes and 51.3 +/- 17.6 minutes in the CABG and PCI groups, respectively (P=.86). In the CABG group, the mean durations of ICU and hospital stays were 3.1 +/- 1.4 and 14.2 +/- 3.7 days, respectively. In the PCI group, the mean durations of ICU stay and hospitalization were 1.7 +/- 0.4 and 7.4 +/- 2.2 days, respectively. Significant differences were found between the 2 groups in terms of the intubation time, duration of ICU stay, and hospitalization periods (P=.001, P=.0001, and P=.001, respectively). No intra-abdominal complications or bleeding was encountered in any group. Postoperative complications of the abdominal wall or mediastinitis were not seen in the setting of concomitant procedures in the CABG group. Conclusion: Simultaneous CABG or PCI with LC may be performed safely in patients with cholecystitis. The durations of postcholecystectomy ICU stay and the intubation time were significantly lower in the PCI group. According to our results, PCI may be the first choice of revascularization procedure in selected patients requiring cholecystectomy prior to discharge.