Cholecystectomy During Abdominal Aortic Aneurysm Repair in Patients with Gallstones

Background: Simultaneous cholecystectomy for asymptomatic cholelithiasis during abdominal aortic aneurysm (AAA) repair is not widely accepted. We reviewed our data to determine morbidity and mortality in patients with cholelithiasis undergoing AAA repair. Methods: Over the past 5 years, 320 infrarenal AAA repairs were done in our institution. Twenty-nine patients were identified as having had a prior cholecystectomy, leaving 291 patients in the study group. Forty-seven patients (16%) were found to have cholelithiasis. Thirty patients underwent a cholecystectomy at the time of the AAA repair (GpA), whereas 17 patients did not have their gallbladder removed (GpB). Patient characteristics, postoperative complications, and mortality were compared. Results: Two patients in GpA died (6.7%), one of renal failure and the other of respiratory failure. In GpB there were three deaths (17.6%) due to postoperative hemorrhage. No deaths in either group were related to the biliary tract. Ten infectious complications occurred in six patients in GpB (35%), compared with only 10% of patients in GpA (p<0.05). Cholecystitis occurred in 24% of patients in GpB, with no cases in GpA (p<0.02). Complications directly related to the biliary tract occurred in 35% of patients in GpB (p<0.02). Conclusions: These data indicate that asymptomatic gallstones resulted in significant morbidity during the postoperative recovery period from AAA repair. We conclude that patients with asymptomatic gallstones should undergo routine cholecystectomy at the time of the AAA repair.