Results of early laparoscopic cholecystechtomy in patients with acute calculous cholecystitis and concomitant ischemic heart disease
Journal Title: Хірургія України - Year 2018, Vol 0, Issue 1
Abstract
The aim — to evaluate the results of early laparoscopic cholecystectomy (LC) in patients with acute calculous cholecystitis (АСС) and concomitant ischemic heart disease. Materials and methods. The study included 107 patients with ACC: 56 (47.7 %) women and 51 (52.3 %) men aged 55 to 82 years old, on average 70.2 ± 0.6 years, treated at the surgical department. All patients were hospitalized within 29.9 ± 1.4 hours. Among all patients with angina pectoris 93 (86.9 %) had stable variant, 14 (13.1 %) — unstable, 6 (6.5 %) patients have had I class of stable angina pectoris, II class have had 45 (48.4 %), III class — 31 (33.3 %), IV class — 11 (11.8 %) of patients. According to NYHA classification, functional class of chronic heart failure (CH) had been diagnosed in 8 (7.5 %) patients, II class — in 59 (55.1 %), III class — in 33 (30.8 %), IV class — in 7 (6.5 %) of cases. 29 (27.1 %) patients have had atrial fibrillation, including permanent form in 19 (65.5 %), paroxysmal form — in 10 (34.5 %) of patients. ESV had been reported in 5 (4.7 %) patients. According to the classification of TG13, the severity of ACC variates: I grade in 37 (34.6 %) patients, II grade — in 41 (38.3 %), and grade III — in 29 (27.1 %) of patients. Anticoagulant and antiplatelet therapy before surgery was given to 95 (88.8 %) of patients. The frequency of catarrhal, phlegmonous and gangrenous forms of LC was 46 (43.0 %), 29 (27.1 %), 32 (29.9 %), respectively. In 47 (43.9 %) of patients there was a paracystic infiltrate, in 14 (13.1 %) — paravesical abscess, in 12 (11.2 %) — local peritonitis. LC (with the creation of carboxyperitoneum 12 — 15 mm Hg) is performed on average 41.1 ± 1.3 hours from the onset of the disease. The method of choice for anesthesia was total intravenous anesthesia (TIVA) with trachea intubation and artificial lung ventilation. The study points were cardiac events in the intraoperative and early postoperative periods. Results and discussion. ECG-signs of intraoperative myocardial ischemia appeared in 23 (21.5 %) patients with duration ranged from 10 up to 25 min, on average 14.8 ± 0.7 min, systolic blood pressure (SBP) < 70 mm Hg decreasing for 5 — 15 min (on average 7.7 ± 0.4 min) registered in 31 (29.0 %) patients; decreasing diastolic blood pressure < 50 mm Hg — in 12 (11.2 %) patients, lasting from 5 to 15 min, on average 8.1 ± 0.4 min. Episodes of reduced saturation level occured in 50 (46.3 %) patients. Bilateral bundle branch block occurred in 9 (8.4 %) patients and atrial fibrillation paroxysms occurred in 9 (8.4 %) patients. Elevated tissue bleeding was observed in 18 (16.8 %) of patients. Stepping up in the NYHA class in the postoperative period occurred in 13 (12.1 %) patients. In this case, the intensification of heart failure occurred in 9 patients from HF II to HF III, and in 4 patients from HF III to HF IV. The deepening of HF correlated with a hemoglobin decreasing < 100 g/L (r = 0.704), episodes of decreasing SBP < 70 mm Hg (R = 0.569), decreased saturation (< 90 %) (r = 0.547), ischemia during anesthesia (r = 0.363), duration of operation (r = 0.495), and negatively correlated with MET (r = –0.436). The ratio of chances for HF deepening in patients with destructive cholecystitis to non-destructive cholecystitis is 11.02 (95 % DM: 1.4 — 88.2). Myocardial infarction (MI) developed in 6 (5.6 %) patients (Q-infarction — in 2, and non Q-infarction — in 4). The occurrence of MI correlated significantly with the intensification of the heart failure (r = 0.438), hypercoagulation before surgery (r = 0.333) and a hemoglobin decreasing < 100 g/L during the operation (r = 0.311). Conclusions. In patients with ACC and concomitant IHD, myocardial ischemia was observed in 21.5 % of patients with early LC. Blood pressure lowering: systolic (< 70 mm Hg) in 29.0 %, diastolic (< 50 mm Hg). Besides that, 11.2 % of patients have had reduction of saturation level (< 90 %) in 46.3 %, new episodes of cardiac arrhythmia in 16.8 %, increased bleeding in 16.8 %. Intensification of HF and MI in the postoperative period occurs in 12.1 % and 5.6 % of patients, respectively. Complications for the cardiovascular system correlate with the form of ACC and its severity class (TG13), NYHA class, FC for angina pectoris, MET level, changes in the hemostatic system (hyper- and hypocoagulation), and preliminary anticoagulant therapy.
Authors and Affiliations
V. G. Mishalov, S. O. Kondratenko, L. Yu. Markulan
Keywords
Related Articles
- EP ID EP279667
- DOI -
- Views 162
- Downloads 0
Acute carcinomatous pancreatitis in patients with pancreatic head cancer complicated by obstructive jaundice
The aim — to improve the diagnostic and surgical palliative treatment results in patients with unresectable pancreatic head cancer, complicated by obstructive jaundice with the canceromatous pancreatitis. Materials and...
Surgery with minimally invasive technologies for acute infected pancreatic necrosis in an elderly patient. Case report
One of the main problems in the treatment of pancreatic necrosis continues to be the choice of the most rational surgical tactics. The wide use of minimally invasive technologies in the complex treatment of acute pancrea...
Surgery for total and subtotal neck contractures with pre-expanded posterior cervicothoracic, cervicoshoulder, and parascapular flaps
Restoration of adequate skin coverage, movements and aesthetic neck contours for the anterior chest lesion, as the main donor sites, is one of the important problems of reconstructive surgery. The aim — to improve the s...
Focal necrosis of the caecum
The current work presents the observation of a rare pathology simulating an acute appendicitis — a caecum focal necrosis or a nonocclusive infarction of a blind gut. Based on the analysis of literature and gained materia...
Dynamics of gunshot wound microbial contamination during complex surgical treatment
The aim — to improve results of surgical treatment for victims with infected gunshot wounds in soft tissues due to implementation of the complex multifactor surgical treatment. Materials and methods. The comparative anal...