Definitive surgical treatment of cholelithiasis in selective patients with liver cirrhosis.
A review of 132 cirrhotic patients with cholelithiasis was carried out. Of the 87 patients who underwent definitive surgical procedures for gallstones, patients of Child's A grade had less operative blood loss, blood transfusion and shorter hospital stay than those of B and C grades. No mortality in cirrhotic patients with Child's A and B grade was found in both emergency and elective surgery. Emergency operation in patients with Child's C grade resulted in more operative blood loss and requirement than elective surgery. Patients in this grade had also a higher morbidity rate and four deaths ensued. Of the 83 survivals after definitive procedures, 78 patients (93.9%) were still alive in the following 62.8 months without any biliary tract symptoms. Of patients who survived after cholecystolithotomy, 6 patients (33.3%) had recurrent stones in the same follow-up period. Therefore, we recommend that definitive biliary surgery be selectively carried out in cirrhotic patients in Child's A and B grade. However, a conservative approach is more suitable in Child's C patients in emergency conditions and definitive procedures should be considered when their liver function improves.
Wu
C C
CC
Department of Surgery, Taichung Veterans General Hospital, Taiwan, R.O.C.
Hwang
C J
CJ
Liu
T J
TJ
D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000379:methods / Q000706:statistics & numerical data; D002768:Choledochostomy / Q000379:methods / Q000706:statistics & numerical data; D002769:Cholelithiasis / Q000145:classification / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000401:mortality / Q000601:surgery*; D008104:Liver Cirrhosis, Alcoholic / Q000145:classification / Q000401:mortality / Q000601:surgery; D008105:Liver Cirrhosis, Biliary / Q000145:classification / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology