Laparoscopic versus open cholecystectomy in cirrhotic patients: a prospective randomized study.
BACKGROUND
Improved laparoscopic experience and techniques have made laparoscopic cholecystectomy (LC) feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy (OC) versus LC in compensated cirrhosis.


METHODS
A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group (55 patients) and LC group (55 patients).


RESULTS
There was no operative mortality. In LC group 4 (7.33%) patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group (96.13+17.35 min versus 76.13+15.12) P<0.05, associated with significantly higher intraoperative bleeding in OC group (P<0.01), necessitating blood transfusions to 7 (12.72%) patients in OC group. The time to resume diet was 18.36+8.18 h in LC group which is significantly earlier than in OC group 47.84+14.6h P<0.005. Hospital stay was significantly longer in OC group than LC group (6+1.74 days versus 1.87+1.11 days) P<0.01 with low postoperative morbidity.


CONCLUSIONS
LC in cirrhotics is still complicated and highly difficult which associates with significant morbidity compared with that of patients without cirrhosis. However, it offers lower morbidity, shorter operative time; early resume dieting with less need for blood transfusion and reducing hospital stay than OC.
El-Awadi
Saleh
S
Mansoura Faculty of Medicine, Department of General Surgery, Mansoura University Hospital, Mansoura, Egypt.
El-Nakeeb
Ayman
A
Youssef
Tamer
T
Fikry
Amir
A
Abd El-Hamed
Tito M
TM
Ghazy
Hosam
H
Foda
Elyamany
E
Farid
Mohamed
M
D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D017558:Elective Surgical Procedures; D005260:Female; D042882:Gallstones / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome