Laparoscopic cholecystectomy for patients with cholelithiasis and liver cirrhosis.
Cirrhosis was considered an absolute or relative contraindication of laparoscopic cholecystectomy. Open surgery in the cirrhotic patients over-years have witnessed of the poor outcome. The present study evaluated the outcome and determined the benefit and risk of the laparoscopic cholecystectomy in cirrhotic patients with symptomatic gall stone. 19 cirrhotic patients (GI) with symptomatic gall stones and 50 non cirrhotic patients or control (GII) underwent the laparascopic cholecystectomy. Four patients (21%) were Child A, MELD score <10, 13 (68%) were Child B, MELD score 10-15, 2 (11%) were Child C, MELD score >15. 15 patients (79%) had chronic calcular cholecystitis, 4 (21%) with acute on top of chronic calcular cholecystitis. Average operative time was 118 minutes. In 3/19 patients (16%) conversion to the open cholecystectomy was mandatory. Laparoscopic subtotal cholecystectomy was done in 2/19 patients (11%). The main hospital stay and time to resume diet were 5.2 days & 43.3 hours. 3 patients received fresh frozen plasma and/or blood transfusion after surgery. No massive blood transfusion (more than 2 units) was necessary. The postoperative complication occurred in 7 patients (37%), ascites was worsened in 2 (11%), hepatic encephalopathy in 2 (11%), port site infection in 2 (11%) and sub hepatic collection in one patient (5.5%). Laparoscopic cholecystectomy in patients with compensated cirrhosis was safe in those with Child A & B. No reason postponed surgery in them as surgery in patients with Child C was hazardous.
Department of General Surgery, Theodoer Bilharz Research Institute, Imbaba P.O. Box 30, Giza, Egypt.
Hesham Abd Elfattah
HA
Rizk
Abdel Aziz Ali
AA
Saleem
D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D016896:Treatment Outcome