Background: The safety of laparoscopic cholecystectomy (LC) has been proven in patients with several
pre-existing clinical conditions. This study was conducted to evaluate the applicability and safety
of elective LC in patients with pre-existing cardiovascular conditions who were receiving anticoagulant
treatment.
Patients and Methods: Between January 1998 and December 2002, 33 patients preoperatively receiving
long-term anticoagulant therapy for pre-existing disease were scheduled to undergo elective
LC for symptomatic gallstone disease in our laparoendoscopic unit. The study group included 19
patients with one valve replacement (57.6%), 1 patient (3%) with two valves replaced, and 1 patient
(3%) with three cardiac valves replaced. There were also 9 patients (27.3%) suffering from
chronic atrial fibrillation, 1 patient (3%)with a history of deep vein thrombosis, 1 patient with a
history of pulmonary embolism, and 1 patient with dilated cardiomyopathy and systemic lupus erythematosous
(SLE). Thirty-three non-anticoagulated patients matched for age and sex who were
scheduled for elective LC in our department during the same period served as the control group.
Results: There was no intraoperative or postoperative mortality or morbidity in our series. The
mean duration of the LC did not differ significantly between the anticoagulated and control groups
(63.6 minutes vs. 64.9 minutes, P = 0.643). All anticoagulated patients were mobilized by postoperative
day 1 and were discharged from the hospital in a mean 3.6 ± 0.8 days (median, 3 days; range,
3–6 days) after an uneventful postoperative course. The length of stay was significantly longer in
the anticoagulated group of patients (3.6 days vs. 1.5 days in the control group, P < 0.001).
Conclusion: Elective LC can be performed safely in patients under anticoagulant therapy for severe
pre-existing cardiovascular disease, as long as their cardiopulmonary and coagulation parameters
are carefully individualized and adjusted.
