**3.1 Cases**

28 Updated Topics in Minimally Invasive Abdominal Surgery

that the advantages of laparoscopic cholecystectomy are more rapid recovery of lung function and a shorter stay in hospital. Catani [4] declared that changes in cardiovascular function due to the insufflation are characterized by an immediate decrease in cardiac index

Popken et al [1] published a study regarding patients with cardiopulmonary impairment where they used laparoscopic cholecystectomy in 19 high-risk patients (ASA IV) and 465 patients with a lower operative risk (ASA I-III). The authors state that out of 484 patients, there were 5 percent who suffered intraoperative cardiopulmonary complications. There were three who belonged to the high-risk group (15.8%) and 21 to the lower risk groups (4.5%). There were general postoperative complications that occurred in 14 cases (2.9%). The authors noted that the number of days spent in hospital was 4.96 to 7.6 in average days in the high-risk group versus 2.23 to 4.8 days in groups ASA I-III. They concluded that highrisk patients shows a raise perioperative rate of complications in laparoscopic cholecystectomy but they also stated that it is not basically a contraindication for this

Tillman et al. [2] also investigated their laparoscopic cholecystectomy cases in 17 patients with severe cardiac dysfunction. They reported that there were three of the 17 patients who required administration of nitroglycerin to maintain the MAP and SVR within the accepted limits while one also required administration of dobutamine to maintain CI. There was no myocardial morbidity or mortality in the perioperative period according to their report. They concluded that laparoscopic cholecystectomy in patients with severe cardiac

It has been believed that patients with diabetes mellitus is considered before as a risk factor in patients who undergo laparoscopic cholecystectomy commonly because of symptomatic gallbladder stones.[5] This is due to reports (Chang,M.D)[6] that a high plasma glucose level is associated with a poor neurologic recovery score in patients after cardiopulmonary

dysfunction results in significant hemodynamic changes.

**3. Patients with diabetes mellitus** 

and an increase in mean arterial blood pressure and systemic vascular resistance.

**2.1 Cases** 

operative method.

Bedirli et al. [8] gathered the data for their laparoscopic cholecystectomy cases where there are eight hundred sixty-two patients with symptomatic gallbladder stones who underwent laparoscopic cholecystectomy. They took into consideration the age, sex, risk classification of the American Society of Anesthesiologists (ASA), laboratory tests, operative records, morbidity and length of hospital stay for each patient. They noted that almost half of their cholecystectomies which comprised 111 patients were performed as acute surgery due to cholecystitis. There were conversions to open surgery which were required in 16% of the diabetic patients undergoing LC. They concluded that when feasible, LC was a safe procedure in diabetes.

Paajanen et al [9] studied 2,548 consecutive patients (1,581 LC, 967 OC) with symptomatic gallstones who underwent cholecystectomy. They summed up that from 1995 and 2008, they operated 227 patients with diabetes 45 of these patients had type 1 diabetes. They made a comparison with the preoperative data and the operative outcome of the diabetic patients who underwent laparoscopic cholecystectomy and open cholecystectomy. They had observed that more complications occur in the open cholecystectomy group than in the laparoscopic cholecystectomy group. Upon their analysis they stated that comorbidities of diabetes were associated with an elevated risk for complications but obesity or acute surgery was not independently associated with postoperative complications. The authors concluded that laparoscopic cholecystectomy is a safe procedure in diabetic patient as compared to open cholecystectomy where there is a significant reduction in operative risks and complications.

Laparoscopic Cholecystectomy in High Risk Patients 31

than the open cholecystectomy (9.8 days) and noted that perioperative outcomes were the same with both techniques. The authors concluded that conservative preoperative transfusion and use of the laparoscopic technique are necessary for patients with sickle cell

Management of gallstones in renal transplant patients was always questioned because of the related complications. It has been found out that patients with renal disease have a higher incidence of coronary artery disease (CAD) and peripheral vascular disease (PVD) compared to the general population because they have the traditional risk factors for CAD such as advanced age, diabetes, hypertension and lipid disorders as well as a high prevalence of such as hyperhomocysteinemia, abnormal calcium phosphate metabolism,

Ekici et al [25] conducted a study where they assessed laparoscopic cholecystectomy (LC) in patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis. There were eleven patients receiving peritoneal dialysis treatment and 33 patients without end-stage renal disease who had undergone an elective LC were compared. They reviewed all their medical records and the laboratory values as well as the outcomes and results. Their peritoneal dialysis group showed a higher frequency of associated disease and previous abdominal surgery, a lower hemoglobin and platelet count and elevated alkaline phosphatase, blood urea nitrogen and creatinine values. There was one procedure in each group that was converted to an open cholecystectomy. There were no other catheter-related complications that occurred. The authors concluded that laparoscopic cholecystectomy may be performed with low complication rates in patients undergoing continuous ambulatory

Banli et al [26] evaluated the outcomes of laparoscopic cholecystectomy in renal transplant patients with symptomatic gallstone disease. They reviewed the records of 155 kidney transplant patients, including 16 patients who underwent laparoscopic cholecystectomy. They found out that the shortest interval time between transplantation and cholecystectomy was 2 years. Surgical morbidity were seen in two of the patients with no mortality and no

disease who will be undergoing cholecystectomy to prevent further complications.

**5. Patients with renal diseases** 

**5.1 Cases** 

anemia, increased oxidative stress and uremic toxins.[27]

peritoneal dialysis with an experienced team.
