Laparoscopic cholecystectomy in cardiac transplant patients - lower threshold for surgery?

Laparoscopic cholecystectomy is accepted by the surgical community as an advance in the definitive treatment of gallstones. In this paper we describe five patients post-cardiac transplantation, in whom laparoscopic cholecystectomy was undertaken. One patient, who had two previous laparo-tomies, required conversion to an open cholecystectomy. In each case the gallstones were symptomatic and were a major cause of morbidity. The average hospital stay was 4 days in uncomplicated cases, but was prolonged in one patient who required stabilization of cyclosporin levels (7 days) and in one patient due to a sub-hepatic collection (17 days). This was successfully treated by percutaneous ultrasound guided drainage. The technical problems of laparoscopic cholecystectomy are no different in transplant patients but it may have the advantage of being less immunotraumatic and allow earlier mobilization. Laparoscopic cholecystectomy is an advance in the treatment of gallstones and because of the risks of acute cholecystitis in cardiac transplant patients, should lower the threshold to definitive surgery.