Cholecystectomy in high-risk patients: a comparison between open cholecystectomy and laparoscopic cholecystectomy

Laparoscopic cholecystectomy offers many advantages, yet patients with a history of cardiopulmonary problems are at an increased risk because of the hemodynamic and respiratory effects of pneumoperitoneum. Between June 1990 and November 1997, a laparoscopic cholecystectomy was performed on 31 high risk patients [American Society of Anesthesiology (ASA) IV] and 40 conventional cholecystectomies were performed on patients with the same operative risk (ASA IV). In total, 15.5% (n=11) of these patients experienced intraoperative cardiopulmonary complications, occurring with approximately the same frequency in both groups. General post-operative complications were seen in 28.2% (n=20) of all cases, the conventionally operated patients were more often affected [37.5%; (n=15) versus 16.1% (n=5) (p<0.05)]. The hospital stay was longer for patients with an open cholecystectomy, at 13.9+/-8.7 days, in comparison to those with a laparoscopic cholecystectomy, at 7.8+/-5 days (p<0.001). In high risk patients there is an increased rate of perioperative complications; this study shows the intraoperative risk is the same, but the post-operative complication rate is lower for laparoscopic cholecystectomy.