Cholecystectomy in the presence of a large patent foramen ovale: laparoscopic or open?
An obese patient with cholelithiasis and acute cholecystitis was scheduled for an emergency laparoscopic cholecystectomy. On preoperative workup, a 5-year-old echocardiogram showed a large patent foramen ovale (PFO) with a right-to-left shunt that was open at rest. Noting both the benefits of laparoscopic surgery and the substantial incidence of PFO in the general population (10% to 30%), the attending and consulting surgeons reasoned that the benefits of laparoscopy greatly exceeded an immeasurably small risk of paradoxical emboli.
Department of Anesthesia and Perioperative Care, the University of California, San Francisco, CA 94143-0648, USA.
Mark S
MS
Thoma
John
J
Maa
Nelson B
NB
Schiller
Lawrence
L
Litt
D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D041881:Cholecystitis, Acute / Q000601:surgery*; D002769:Cholelithiasis / Q000601:surgery; D019320:Embolism, Paradoxical / Q000209:etiology; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications