Clinical Outcomes of Synchronous Laparoscopic Cholecystectomy with Coronary Artery Revascularization

  • Dogan Kahraman Department of Cardiovascular Surgery, Gaziantep University School of Medicine, Gaziantep, Turkey
  • Ihsan Sami Uyar Department of Cardiovascular Surgery, Kirsehir Ahi Evran University School of Medicine, Kirsehir, Turkey
  • Umit Duman Department of Cardiovascular Surgery, Koc Vakfi American Hospital, Istanbul, Turkey
  • Ibrahim Sami Karaca Department of Cardiovascular Surgery, Kirsehir Ahi Evran University School of Medicine, Kirsehir, Turkey
  • Dilek Dogan Department of Nutrition and Dietetics, The Health Science University, Adana City Hospital, Adana, Turkey
  • Kevser Tural Department of Cardiovascular Surgery, Kafkas University School of Medicine, Kars, Turkey
  • Omer Faruk Dogan Department of Cardiovascular Surgery, Kafkas University School of Medicine, Kars, Turkey
  • Atif Akcevin Department of Cardiovascular Surgery, Koc Vakfi American Hospital, Istanbul, Turkey
Keywords: Coronary artery bypass grafting, percutaneous coronary intervention, synchronous general surgery


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.


Alvino DML, Fong ZV, McCarthy CJ, et al. 2017. Long-term outcomes following percutaneous cholecystostomy tube placement for treatment of acute calculous cholecystitis. J Gastrointest Surg 21(5):761-9.

Benahmed A, Kianda M, Ghisdal L, et al. 2014. Ticlopidine and clopidogrel, sometimes combined with aspirin, only minimally increase the surgical risk in renal transplantation: a case-control study. Neprol Dial Transplant 29(2):463-6.

Bilge Erdogan M, Kaplan M, Kazaz H, Salman B. 2017. Synchronous open heart surgery and laparoscopic cholecystectomy: an observational case study with 28 patients. Am Surg 83(3):314-21.

Charokopos N, Antonitsis P, Spanos C, Rouska E, Spanos P. 2007. Concomitant cholecystectomy and open heart surgery. Surg Today 37(8):638-41.

Chernoguz A, Telem DA, Chu E, Ozao-Choy J, Tammaro Y, Divino CM. 2011. Cessation of clopidogrel before major abdominal procedures. Arch Surg 146(3):334-9.

Hekmat M, Taghipoor HR, Nobahar MR, et al. 2005. Laparoscopic cholecystectomy and open-heart surgery at the same time. J Card Surg 20(6):557-9.

Helft G. 2016. Dual antiplatelet therapy duration after drug-eluting stents: how long? J Thorac Dis 8(8):E844-6.

Hirose H, Amano H, Takahashi A. 2002. Concomitant cholecystectomy and coronary artery bypass. Ann Thorac Cardiovasc Surg 8(6):358-62.

Hoshino R, Okubo T, Kaneko K, Gushiken S, Sato M. 1989. [Concomitant coronary artery bypass and cholecystectomy: a case report]. Kyobu Geka 42(12):1043-6. Japanese

Koike R, Kimura H, Sugihara J, et al. 1991. [Simultaneous coronary artery bypass grafting and cholecystectomy: a report of three cases]. Kyobu Geka 44(2):145-50. Japanese.

Lee JJ, Hwang SM, Kim HS, et al. 2010. Acute fatal postoperative myocardial infarction after laparoscopic cholecystectomy in a cardiac patient: a case report. Korean J Anesthesiol 59(suppl):S110-3.

Levine GN, Bates ER, Blankenship JC, et al. 2011. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 124(23):e574-651.

Mangi AA, Christison-Lagay ER, Torchiana DF, Warshaw AL, Berger DL. 2005. Gastrointestinal complications in patients undergoing heart operation: an analysis of 8709 consecutive cardiac surgical patients. Ann Surg 241(6):895-901; discussion 901-4.

Ohri SK, Desai JB, Gaer JAR, et al. 1991. Intraabdominal complications after cardiopulmonary bypass. Ann Thorac Surg 52(4):826-31.

Perugini RA, Orr RK, Porter D, Dumas EM, Maini BS. 1997. Gastrointestinal complications following cardiac surgery:an analysis of 1477 cardiac surgery patients. Arch Surg 132(4):352-7.