Laparoscopic cholecystectomy with severe COPD

PIG Meeting: 18th February 2021

67 year old lady for elective laparoscopic Cholecystectomy

Background

  • Recent admission for obstructive cholangitis

Issues

  • Moderate-severe COPD.
  • Current smoker
  • Recent deterioration in exercise tolerate to 20-30m. NYHA class 3 dyspnoea.
  • Spirometry significantly deteriorated from previous. FEV1 = 0.63 (30% pred), FVC 0.94.
  • No active infection
  • On Clozapine under psychiatry care for schizophrenia

Discussion

  • Are there any alternatives to surgery? ERCP and sphincterotomy or stent?
  • Requires further discussion with surgical team, laparoscopic cholecystectomy is usual pathway for these patients 
  • Requires respiratory assessment and optimization. Potential benefits of perioperative steroid therapy
  • Cardiac assessment given on clozapine? Has echocardiogram booked to review any possible cardiac complication of clozapine therapy
  • Suggestion of potential benefits of preoperative hospital admission for respiratory optimization
  • Smoking cessation discussed

Plan

  • Defer for 4 weeks while awaiting respiratory review and echocardiogram
  • Further discussion with surgical team regarding respiratory co-morbidities and surgical options
  • Liaise with psychiatry team given current clozapine therapy