Laparoscopic cholecystectomy in cirrhosis: contraindication or privileged indication?
Until recently, cirrhosis has been considered to be an absolute or relative contraindication of laparoscopic cholecystectomy. An evaluation of benefits and risks of laparoscopic cholecystectomy in the treatment of gall bladder lithiasis in cirrhotic patients is presented. Thirty-three consecutive laparoscopic cholecystectomies in patients with cirrhosis were performed between March 1990 and March 1997. During the same period, no open cholecystectomy was performed in patients with cirrhosis. There was no morbidity or mortality; the conversion rate was 6% (2/33). No patient received blood transfusion, and the mean hospital stay was 2.8 days. These results favorably compare with the results of open cholecystectomy. Specific advantages of laparoscopic cholecystectomy in patients with cirrhosis include the absence of wound infection and a lower rate of postoperative hepatic failure. Finally, laparoscopic surgery reduces the risk of viral contamination (the hepatitis B virus, the hepatitis C virus, or the human immunodeficiency virus) of the surgical staff.
Morino
M
M
Dipartimento di Discipline Medico-Chirurgiche dell'Università di Torino, Clinica Chirurgica Generale ed Oncologica, Corso AM Dogliotti, Italy. mmorino@ddmc.unito.it
Cavuoti
G
G
Miglietta
C
C
Giraudo
G
G
Simone
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000009:adverse effects / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000401:mortality; D002769:Cholelithiasis / Q000150:complications* / Q000601:surgery*; D000075202:Contraindications; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000097:blood / Q000145:classification / Q000150:complications*; D017093:Liver Failure / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014946:Wound Infection / Q000209:etiology / Q000517:prevention & control