BACKGROUND:
Cardiovascular disease (CVD) and
gallstones are reported to be strongly associated because both diseases are frequently part of a
metabolic syndrome. Laparoscopic cholecystectomy (LC) has become the
standard treatment for
gallbladder disease around the world.
Cardiovascular disease is considered as an absolute or relative contraindication for LC; however, clinical information regarding the applicability of LC for treating
gallbladder disease in CVD patients is lacking. This study aims to assess the suitability of LC for the treatment of
gallbladder disease in CVD patients. METHODS: The medical records of 66 patients with severe CVD (including
valvular heart disease,
ischemic heart disease, and
heart failure) and
gallbladder disease (CVD-group) who underwent LC between 1966 and 2005 were retrospectively reviewed. Furthermore, these data were compared with the clinical features and outcomes of 8,834 patients with
gallbladder disease who underwent LC but did not have severe CVD (NCVD-group). RESULTS: Of the 8,900 patients with
gallbladder disease undergoing LC, the 66 (0.74%) who comprised the CVD-group clearly exhibited
advanced age, male predominance, higher
blood urea nitrogen (
BUN) levels, and a longer duration of hospitalization as compared with the NCVD-group patients. A longer duration of hospitalization and a higher incidence of acute
cholecystitis and
chronic cholecystitis were identified as independent factors differentiating the CVD-group patients, who had previously undergone
open-heart surgery, from the NCVD-group patients who underwent LC. For the CVD-group patients, adjustment of
anticoagulant therapy contributed to the longer duration of hospitalization, but postoperative complications did not.
Advanced age and male predominance were identified as independent factors differentiating the patients who developed
ischemic heart disease that required intervention from the NCVD-group patients undergoing LC. The operative
morbidity and
mortality rates of LC are likely to be similar when it is used to treat
selected patients with severe CVD and
gallbladder disease and when it is used to treat patients with
gallbladder disease and no CVD. CONCLUSIONS: Laparoscopic cholecystectomy is a suitable procedure for treating
selected patients with severe CVD and
gallbladder disease, and its operative
morbidity and
mortality rates are similar in these patients and in patients with
gallbladder disease alone. Nevertheless, appropriate preoperative preparations and established operative techniques in the
hands of an experienced surgeon are mandatory.
