Laparoscopy in CABG patient - Forum

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सर्जन

Laparoscopy in CABG patient - Ärzteforum

Post#1 »

I would appreciate your opinion on this patient. 55 year old male with DM had CABG 2 years back. Suffered from acute cholecystitis 2 mts back. Resolved with conservative measures. Had another mild attack of abd pain 2 days back. He wants lap cholecystectomy. I haven't done lap cholecystectomy on patient with CABG.


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Surgeon

Re: Laparoscopy in CABG patient - Ärzteforum

Post#2 »

A patient after a successful CABG is in better shape than before it. In the absence of active myocardial ischemia or congestive heart failure go ahead with LC. We trust that you know when to convert.

forceps

Re: Laparoscopy in CABG patient - Ärzteforum

Post#3 »

Why do we try to make things so complicated for ourselves????? What in the world does a history of a CABG have to do with the indications for, or technique of, cholecystectomy? The patient should have had his cholecystectomy at the time of his first attack of cholecystitis, according to the current standard of care--now what a surprise--he is having more attacks. Is the worry about the heart? Why? It's been fixed! What do you think is liable to do more damage to the heart, or to the patient--one straightforward cholecystectomy, or multiple attacks of acute cholecystitis?

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Resident

Re: Laparoscopy in CABG patient - Ärzteforum

Post#4 »

No problems:
1) Most important thing is, how does he feel now; any recent chest pains?, any shortness of breath? If no, but you want to be very careful, asses his cardiac performance- stress ECHO or stress perfusion tests - dobutamine or persantine. But if he doesn't have first 2 signs, and no arrythmias on plain EKG, I would not bother with major cardiology assessment. Remember- presence of chest pains, shortness of breath and arrythmia are most important from his history ( see Goldman criteria) to asses his risks for perioperative cardiac complications, and not the fact that he had CABG, which is a protective factor - they were supposed to fix his coronaries - which I hope they did.
2) Laparoscopic cholecyctectomy is a " minimally invasive operation", and as long as he can sign his check without getting angina, he will do well. ( joke )
3) To make you feel even more relaxed, we do lap. chle. on patiens, who had CABG every day.

The best surgeon

Re: Laparoscopy in CABG patient - Ärzteforum

Post#5 »

No problem in this patient ! Just do a routine pre op cardiac work up with a good history to make sure that the CABG surgery is still open ! Do lap chole with minimum intra abdominal pressure ( 10 maybe ) !

bonjorno

Re: Laparoscopy in CABG patient - Ärzteforum

Post#6 »

What is CABG ?

Stent

Re: Laparoscopy in CABG patient - Ärzteforum

Post#7 »

I would do the CABG first then come back for the gallbladder several weeks later. I trained in a conservative hospital where we never did combined CABG and Chole for fear of ontamination/mediastinitis plus one is an urgent case and the other elective.

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A Doctor

Re: Laparoscopy in CABG patient - Ärzteforum

Post#8 »

bonjorno wrote:What is CABG ?


Coronary
Artery
Bypass
Graft
called Cabbage in some local slang

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