Cholecystectomy in patients with cirrhosis. A surgical challenge.
Cholecystectomy or cholecystostomy was performed in 49 patients with cirrhosis with a mortality of 10.2%. Massive intraoperative blood loss was found in 16.3% and major wound problems (dehiscence, abscess) in 12.2%. Intraoperative blood loss, amount of blood transfused, and mortality were correlated with the Child classification of hepatic reserve. Mortality was 23.5% for Child C patients vs 0% for Child A patients. Excessive blood loss from a hypervascular biliary bed and resulting liver failure and sepsis were the usual causes of death. Elective surgical intervention for Child A and B patients with symptomatic cholelithiasis is warranted. In Child C patients, however, every attempt should be made to increase the class to a Child B.
D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000401:mortality; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications