[Biliary calculi in liver cirrhosis. Clinical, epidemiologic & therapeutic aspects].
BACKGROUND
Incidence of cholelithiasis in cirrhotic patients is twice of threefold that in non cirrhotic one. Cholelithiasis is often asintomatic, however, when complications occur, emergency surgery is burden by high rates of morbidity and mortality. Purpose of the current study is to state the clinical features and to assess the outcome of elective surgery in these patients.


METHODS
Sixtyseven consecutive patients with liver cirrhosis (Group A) who underwent elective surgery for biliary stones were retrospectively reviewed. Preoperative clinical features, surgical procedure, postoperative morbidity and morality were recorded and compared with those of the 3291 non cirrhotic patients (Group B) observed in the same period and submitted to elective surgery for biliary stones.


RESULTS
Stone involvement of the biliary tract (A vs B:31.3% vs 20.5%), cholangitis (A vs B:23.8% vs 13.0%) and acute biliary pancreatitis (A vs B:4.4% vs 0.7%) were found to be more frequent among cirrhotic patients. In Group A postoperative morbidity and mortality in Child-Pugh A and B were found to be not statistically different from those of Group B patients.


CONCLUSIONS
Authors conclude that definitive biliary surgery may be considered as a successful and safe indication in the treatment of cirrhotic patients in Child-Pugh A and B grade. Conservative approaches are considered as more suitable in Child-Pugh C patients, and definitive elective procedures should be considered for these patients only when an improvement of their liver function can be achieved.
Tocchi
A
A
Istituto di Clinica Chirurgica, Università degli di Roma.
Liotta
G
G
Lepre
L
L
Costa
G
G
Mazzoni
G
G
Sita
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D002769:Cholelithiasis / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
Litiasi biliare in corso di cirrosi epatica. Considerazioni clinico-epidemiologiche e di terapia.