title: [Laparoscopic cholecystectomy in patients with liver cirrhosis].
abstract: BACKGROUND
  Initially considered a contraindication to the surgical laparoscopy, cirrhosis have been an occasional discovery during this procedure. Until now many series reported in the literature suggest that the majority of the surgeons still consider cirrhosis as contraindication to the laparoscopic cholecystectomy.
  
  
  OBJECTIVE
  To evaluate our experience in laparoscopic treatment of the cholelithiasis in cirrhotic patient.
  
  
  METHODS
  Six hundred and four patients with symptomatic cholelithiasis were operated on Clinical and Surgical Gastroenterology Unit, "Santa Casa de Misericórdia de Porto Alegre", Porto Alegre, RS, Brazil, during the period from May 1993 to May 2000. Of these, 10 (1,6%) presented hepatic cirrhosis. The patients' age was between 22 and 69 years (average of 50,4 +/- 18,1). Eight patients (80%) were female. The alcohol was the etiological factor in four, chronic hepatitis B and C, primary biliary cirrhosis and of alfa-1 antitripsin deficiency in one patient each. In two patient the causal agent was not identified.
  
  
  RESULTS
  Cholecystectomy was accomplished in all patients and in seven also diagnostic hepatic biopsy. In two (20%) the surgery was converted. The result of the intraoperative cholangiography was normal in all cases. In seven patients the postoperative was uneventfull. Clinically controlled ascite was observed in two (20%). Both were Child A at the moment of the surgery. The last patient, Child C, died. He presented irreversible hepatic failure.
  
  
  CONCLUSIONS
  Despite larger experience still should be acquired, it seems that laparoscopic is a safe approach in well compensated cirrhotic patients with symptomatic cholelithiasis. In Child C patients we believed that all of the efforts should be driven to the improvement of the hepatic function or a less invasive method such as cholecystostomy.
authors.affiliation: Serviço de Gastroenterologia Clínica e Cirúrgica, Complexo Hospitalar da Santa Casa de Porto Alegre, Porto Alegre, Brasil. prfontes@santacasa.tche.br
authors.forename: Paulo Roberto Ott
authors.initials: PR
authors.lastname: Fontes
authors.forename: Angelo Alves
authors.initials: AA
authors.lastname: de Mattos
authors.forename: Rene Jacobsen
authors.initials: RJ
authors.lastname: Eilers
authors.forename: Mauro
authors.initials: M
authors.lastname: Nectoux
authors.forename: Jorge Olavo Pitta
authors.initials: JO
authors.lastname: Pinheiro
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000592:standards; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome