**6. References**


uncomplicated lithiasis is related to the need for more time for dissection and hemostasis. Two superficial wound infections, 2 postoperative subhepatic collections and a third at 9 months after surgery treated by percutaneous puncture and a biliary leak through drainage for 15 days with spontaneous closure are noteworthy complications. At least 3 days of

In our experience, common bile duct exploration presents no special difficulties except juxtapapillary interlocking stone, making it difficult to remove. The location of the bile duct, dissection, and preparation is as simple as in open laparotomy. In 30 cases we performed transcylindrical choledochotomy with an average of 119 minutes, with a range between 70 and 182 minutes of the proceedings. A stone inpacted in a dilated common bile duct required a choledochoduodenostomy. One patient experienced postoperative bleeding

Despite technological advances and the practice of surgery becoming more expensive, we developed a technique for the treatment of gallstones and its complications achievable with natural view of the structures and conventional reusable material. The technique has proven to be fast simple and safe, applicable to all patients. Local anesthesia and sedation provides a quick recovery and many patients lose the fear of the intervention. Both in acute cholecystitis in choledocholithiasis we have obtained good results. The patients suspected of choledocholithiasis are operated and an intraoperative cholangiography is made. The transcylindrical exploration of the common bile duct is performed whenever introperative

Arendt, SA. & Pitt, HA. (2004) Biliary Tract. In: *Sabiston Textbook of Surgery: The Biological* 

Assalia, A., Kopelman, D., Hashmonai, M. (1997). Emergency minilaparotomy

Bartlett, MK., & Waddell, WR. (1958). Indications for common duct exploration. Evaluation

Britton, J., & Bickerstaff, KI (1994). Benign Diseases of the Biliary Tract. In: *Oxford Textbook of* 

Classen, M., & Demling, L. (1974). Endoscopic sphincterotomy of the papilla of vater and

Cooperman, AM. (1990). Laparoscopic cholecystectomy for severe acute, embedded, and

Craig, DB. (1981). Postoperative recovery of pulmonary function. *Anesth Analg*, Jan 1981, vol

*Basis of Modern Surgical Practice.* Townsend, CM., Beauchamp, RD., Evers, BM., & Mattox, KL., editors, pp. 1597-1641. 17th edition. Elsevier Saunders, ISBN 0-8089-

cholecystectomy for acute cholecystitis: prospective randomized trial--implications for the laparoscopic era. *World J Surg* 1997, Vol. 21, No. 5, pp. 534-9. ISSN 0364-2313.

in 1000 cases. *New Eng J Surg* 1958, Jan 23, Vol. 258, no. 4, pp. 164-7, ISSN:0028-4793.

*Surgery* Morris, PJ., & Malt, RA., editors. Oxford University Press, pp. 1209-1241.

extraction of stones from the choledochal duct. *Deutsch Med Wochenschr* 1974, Mar

gangrenous cholecystitis. *J Laparoendosc Surg* 1990, Vol. 1, No. 1, pp. 37-40. ISSN

hospitalization and antibiotic treatment follow the surgery.

requiring intervention without finding the bleeding point.

cholangiography demonstrated stones.

2295-5, Philadelphia.

ISBN 0192626035, New York.

1052-3901.

15, Vol. 99, N0.11, pp. 496-7, ISSN 0012-0472.

60, No. 1, pp. 46-52, ISSN 0003-2999.

**5. Conclusion** 

**6. References** 


**2** 

**Laparoscopic Cholecystectomy** 

High risk patients who are candidates for laparoscopic cholecystectomy differ from the patients who have no existing risks and comorbidities in terms of the methods to be used as well as the expected outcomes. In order to recognize the safety of laparoscopic cholecystectomy, different cases of high risk patients undergoing laparoscopic cholecystectomy were gathered which demonstrate their conditions during laparoscopic cholecystectomy. These articles focused on patients with cardiopulmonary diseases, diabetes mellitus, sickle cell diseases, renal diseases, liver cirrhosis, during pregnancy and in the elderly. The results of the different cases showed that laparoscopic cholecystectomy is a safe procedure to be utilized and it is therefore recommended as the treatment of choice, as long as it is done cautiously and skillfully in all the high risk groups. The consequences of this technique including the bile duct injury, influence of pneumoperitoneum on cardiorespiratory system and other complications are outweighed by the benefits that the

Patients who are high risk and undergo traditional cholecystectomy carries high morbidity and mortality as compared to laparoscopic cholecystectomy. The introduction of laparoscopic cholecystectomy has decreased the number of contraindications in the past recent years and in which more studies are focused on the constant modifications in terms

Patients who have past or recent medical conditions who are at risk of presenting perioperative complications and those who cannot survive an operation are the ones classified as high risks patients.[2] The issue that is always brought up for patients with such conditions is whether the benefits of laparoscopic cholecystectomy offset the risks involved especially with the new methods used in the procedure such as CO2 insufflation and

There are collated cases which demonstrate the conditions of the high risks patients during laparoscopic cholecystectomy. These articles focused on patients with cardiopulmonary diseases, diabetes mellitus, sickle cell diseases, renal diseases, liver cirrhosis, during

Hemodynamic and respiratory effects of the pneumoperitoneum are the most common

hazards of surgical intervention in cardiac and pulmonary disease patients.

of the assessed risks as well as the indications for the procedure.[1]

**1. Introduction** 

patients acquire after the surgery.

pneumoperitoneum.[3]

pregnancy and in the elderly.

**2. Patients with cardiopulmonary diseases** 

**in High Risk Patients** 

Abdulrahman Saleh Al-Mulhim

*King Faisal University* 

*Saudi Arabia* 

Popken[1] stated

