Clinical Outcomes of Synchronous Laparoscopic Cholecystectomy with Coronary Artery Revascularization
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.
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).