Laparoscopic cholecystectomy in patients with hepatic cirrhosis: a five-year experience.
Our institution is a tertiary referral center that specializes in hepatobiliary surgery. To evaluate the safety, efficacy, and conversion rate of laparoscopic cholecystectomy in patients with hepatic cirrhosis, we conducted a retrospective analysis of all cirrhotic patients undergoing attempted laparoscopic cholecystectomy during the period from 1991 to 1996. The diagnosis of cirrhosis was made on the basis of either a preoperative history, a liver biopsy, or the surgeon's operative description of the liver. All patients had early, well-compensated cirrhosis (Child's class A or B). A total of 30 patients underwent attempted laparoscopic cholecystectomy and five patients were converted to an open procedure (17%). The conversion rate for elective cases was 5% compared with 36% for urgent procedures. Two patients were converted because of varices and three because of unclear anatomy. No patients were converted because of bleeding. There were no operative deaths. The complication rate for elective procedures was 16%, with an average length of stay of 2.1 days, compared with 36% and 4.8 days, respectively, for urgent cases. Laparoscopic cholecystectomy in patients with early, well-compensated cirrhosis is safe and should be the treatment of choice for these patients.
Friel
C M
CM
Department of Surgery, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Stack
J
J
Forse
A
A
Babineau
T J
TJ
D016063:Blood Loss, Surgical; D001900:Boston / Q000453:epidemiology; D016009:Chi-Square Distribution; D002763:Cholecystectomy / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000706:statistics & numerical data; D002769:Cholelithiasis / Q000601:surgery; D017558:Elective Surgical Procedures; D004630:Emergencies; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012449:Safety; D015996:Survival Rate; D016896:Treatment Outcome