Effect of nonbiliary problems on laparoscopic cholecystectomy.
Laparoscopic cholecystectomy may be performed safely in most patients with symptomatic cholelithiasis. There are few absolute contraindications to laparoscopic cholecystectomy. Many relative contraindications exist, which relate to the surgeon's experience and the ability of the operating team to manage potential complications. Preoperative evaluation should assess the potential nonbiliary problems that affect the performance of laparoscopic cholecystectomy, including severe cardiopulmonary disease, coagulopathy, cirrhosis, and pregnancy. Since most therapeutic laparoscopic procedures are currently performed with a carbon dioxide (CO2) pneumoperitoneum, the physiologic effects of the elevated abdominal pressure and absorbed CO2 must be understood by the surgeon. Specific nonbiliary problems addressed in this review are cardiopulmonary disease, hypercortisolism, cirrhosis and portal hypertension, morbid obesity, previous abdominal surgery, and pregnancy.
Soper
N J
NJ
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.
D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis; D001778:Blood Coagulation Disorders / Q000150:complications / Q000175:diagnosis; D002245:Carbon Dioxide / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D000075202:Contraindications; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000175:diagnosis; D010537:Peritoneum; D010538:Peritonitis / Q000150:complications / Q000175:diagnosis; D011028:Pneumoperitoneum, Artificial; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery; D011300:Preoperative Care; D014481:United States
D002245:Carbon Dioxide