Expert: Dr Ian Jackson - please note UK based - 6/4/2011

Question
Hello,
My father had an Ischemic right Middle cerebral artery stroke in last August due to 2 month Aspirin off and after that he has been doing well ever since but last week he had a post stroke seizure and the reason of this seizure was the reduced amount of Valproic acid in blood. he is taking Aspirin plus clopidogrel drug, anticonvulsant drugs (Epival 250mg , Topiramate )and Ropinirole etc. he has gallstone of about 9 cm and doctor advised him to go Laparoscopy but The neurophysician says it's too risky. Is his risk of stroke or other complications under general anesthesia significantly greater? gallstone is creating many complication for pancreas and liver.My father had pancreatitis in last year and still he has a little elevated serum Lipase and amylase and also have low SGPT enzyme and high gamma GT .... please guide me what should i do ???

Answer
Hi there
There is no doubt that your father would be a high risk patient for surgery given his history of stroke. Especially as the surgeons would probably want to stop his clopidogrel and aspirin. This is the main reason why he would be at risk of stroke.However any problems with low blood pressure or even high blood pressure during or after the operation would increase his risk of stroke.
However I cannot really guide you as to the risks of not having surgery for his gallbladder problem. What I can say is that the 9cm gallstone is unlikely to cause any issue with pancreatitis as it is too big to get into the bile duct. However he may well have smaller stones that are causing problem.
Overall I always err on the side of caution - why take the risk just because the gallbladder might cause him further problems? In the end this is a decision for your father and he must decide between the two routes only he knows how disabled he feels with his gallbladder problem.
Kind regards
Dr Ian Jackson