Laparoscopic-assisted colectomy in patients with liver cirrhosis.
BACKGROUND
Nonhepatic abdominal surgery, and especially colorectal surgery, is associated with high rates of morbidity and mortality among cirrhotic patients. With proper patient selection and preoperative optimization of the patient's condition, laparoscopic-assisted colectomy could become effective and safe for patients with compensated liver cirrhosis. The aim of this study was to evaluate the safety and feasibility of minimal-access surgery in these patients.


METHODS
Between September 1993 and March 2003, 820 patients underwent laparoscopic-assisted colectomy at our hospital. We studied all patients with liver cirrhosis who underwent this operation.


RESULTS
Seventeen patients with cirrhosis were included in the study. Twelve were Child's A and five were Child's B. The mean operative time was 150 min (ranges 75-280), mean estimated blood loss was 245 ml (ranges 100-250). The conversion rate to open surgery was 29% (five patients). Median length of hospital stay was 5 days. The morbidity rate was 29% (five patients). There were no anastomotic leaks or operative-related deaths. The median follow-up was 21 months.


CONCLUSIONS
Laparoscopic-assisted colorectal surgery can be performed in compensated cirrhotic patients with low morbidity and mortality. Adequate patient selection and expertise in advanced minimal-access surgery are essential to obtain such good results.
Martínez
J-L
JL
Department of Gastrointestinal Surgery, Institute of Digestive Diseases, Colorectal Cancer Unit, Hospital Clinic, University of Barcelona, Corporació Sanitària Clínic, Villarroel 170, 08036, Barcelona, Spain.
Rivas
H
H
Delgado
S
S
Castells
A
A
Pique
J M
JM
Lacy
A M
AM
D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D018253:Adenoma, Villous / Q000150:complications / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016888:Angiodysplasia / Q000150:complications / Q000601:surgery; D016063:Blood Loss, Surgical; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome