Congestive Heart Failure and Gallbladder Disease: Perioperative Risk in Cholecystectomy and Cholecystostomy. A Narrative Review

IntroductionTwo conditions that were once treated as belonging to separate clinical worlds now converge routinely on the same operating list.Gallstone disease remains among the commonest indications for emergency abdominal surgery, and heart failure has become one of the commonest chronic diagnoses carried by the patients who present Review Open AccessAbstract Congestive heart failure and gallbladder disease increasingly occur in the same patient, yet the surgical literature treats their intersection largely as an incidental finding within broader risk-adjustment models.This narrative review draws together three strands of evidence: the mechanisms by which systemic venous congestion alters the gallbladder wall, the diagnostic confusion that arises when decompensated heart failure presents as right upper quadrant pain, and the quantified perioperative penalty that heart failure imposes on cholecystectomy and gallbladder drainage.Administrative database analyses are consistent on the last point.Propensity-matched national data show roughly a doubling of in-hospital mortality after laparoscopic cholecystectomy for acute cholecystitis in patients with heart failure, and a comparable signal is present for acute or decompensated heart failure in earlier surgical quality registries, where pulmonary complications rise three-to five-fold.Congestive heart failure also ranks second only to chronic obstructive pulmonary disease among patient-related predictors of postcholecystectomy pneumonia, and it independently predicts one-year mortality after percutaneous cholecystostomy.The evidence on diagnostic overlap is far weaker, resting almost entirely on individual case reports, but the pattern they describe is consistent enough to be instructive: gallbladder distension with mildly abnormal liver chemistry and unremarkable inflammatory markers should raise the possibility of a cardiac cause.Percutaneous cholecystostomy offers a route around prohibitive anesthetic risk, though recent systematic evidence argues it should be framed as a bridge to interval cholecystectomy at eight to thirteen weeks rather than as definitive therapy, and heart failure is itself among the strongest predictors that the interval operation will never happen.We propose a structured preoperative pathway and identify the development of a cardiac-specific, gallbladder-focused risk score as the principal unmet need.