Cholecystectomy in cirrhotic patients: pitfalls and reasonable recommendations.
Cholecystectomy in cirrhotic patients remains a high risk procedure. The recent literature was reviewed in the objective to elaborate (evidence-based) recommendations for therapeutic decision. In patients with Child Pugh A or B cirrhosis, the laparoscopic approach should be preferred as it is associated with reduced morbidity and mortality as compared with open surgery (level B). In patients with decompensated Child Pugh C cirrhosis, the scarcity of literature data renders much more hazardous the definition of robust recommendations. In these patients, two options have to be considered beyond early laparoscopic cholecystectomy: first, a delayed surgery, in order to improve the preoperative patient's general condition and namely the coagulation, and second, a percutaneous drainage in very severe cases (level C).
Lucidi
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Department of Abdominal Surgery, Hôpital Erasme, Université Libre de Bruxelles (ULB).
Buggenhout
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Donckier
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D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000453:epidemiology* / Q000601:surgery; D015897:Comorbidity; D042882:Gallstones / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000453:epidemiology / Q000601:surgery; D008103:Liver Cirrhosis / Q000453:epidemiology*; D011379:Prognosis