Laparoscopic cholecystectomy is most strongly contraindicated
in which of the following situations?
A. Pregnancy
B. Previous upper abdominal surgery
C. Known common bile duct stones
D. Chronic obstructive pulmonary disease
E. Gallbladder cancer
COMMENTS: When laparoscopic cholecystectomy was first
introduced worldwide during the late 1980s, there were a number
of circumstances in which it was more or less strongly contraindicated.
Today, most contraindications are relative, and in fact the
laparoscopic approach is preferred when possible in certain situations
that were initially considered contraindications (e.g., acute
cholecystitis, choledocholithiasis, and obesity). Basically, the
surgeon must be adequately trained and the patient reasonably fit for
an operation and give informed consent that includes the possibility
of laparotomy. It must be recognized that there are patients for whom
the potential physiologic consequences of CO2 pneumoperitoneum
are more important, but the presence of underlying disease itself
does not prohibit a laparoscopic approach. In fact, laparoscopic
cholecystectomy may be more beneficial to the postoperative course
of a compromised patient. Pregnancy is not a contraindication with
appropriate precautions, although the physiologic effects on the
fetus are not completely known. Perhaps the strongest contraindication
currently involves patients with suspected or known gallbladder
cancer because of the risk for dissemination.
A N S W E R : E
in which of the following situations?
A. Pregnancy
B. Previous upper abdominal surgery
C. Known common bile duct stones
D. Chronic obstructive pulmonary disease
E. Gallbladder cancer
COMMENTS: When laparoscopic cholecystectomy was first
introduced worldwide during the late 1980s, there were a number
of circumstances in which it was more or less strongly contraindicated.
Today, most contraindications are relative, and in fact the
laparoscopic approach is preferred when possible in certain situations
that were initially considered contraindications (e.g., acute
cholecystitis, choledocholithiasis, and obesity). Basically, the
surgeon must be adequately trained and the patient reasonably fit for
an operation and give informed consent that includes the possibility
of laparotomy. It must be recognized that there are patients for whom
the potential physiologic consequences of CO2 pneumoperitoneum
are more important, but the presence of underlying disease itself
does not prohibit a laparoscopic approach. In fact, laparoscopic
cholecystectomy may be more beneficial to the postoperative course
of a compromised patient. Pregnancy is not a contraindication with
appropriate precautions, although the physiologic effects on the
fetus are not completely known. Perhaps the strongest contraindication
currently involves patients with suspected or known gallbladder
cancer because of the risk for dissemination.
A N S W E R : E
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