title: Short-term outcome of total clipless laparoscopic cholecystectomy for complicated gallbladder stones in cirrhotic patients.
abstract: BACKGROUND
  Cirrhotic patients have been known to be more affected with gallstones than their non-cirrhotic counterparts; since laparoscopy was introduced, it has been generally approved as the standard approach for cholecystectomies with the exception of end-stage cirrhosis. The purpose of this study was to evaluate the safety and efficacy of clipless laparoscopic cholecystectomy using the harmonic scalpel in complicated cholelithiasis in cirrhotic patients.
  
  
  METHODS
  This prospective study was conducted on 62 cirrhotic patients presenting to the Gastrointestinal Surgery Unit in Alexandria Main University Hospital with complicated gallstones between March 2013 and March 2016. Both intraoperative time and blood loss were calculated in addition to rates of conversion to open cholecystectomy, morbidity and mortality.
  
  
  RESULTS
  Most of our cases were females with a ratio of 1.7:1, with a mean age of 45.21 years, ranging from 25 to 65 years. The most common cause of cirrhotic liver was hepatitis C in 45.1% of patients. Among the 62 patients included in the study, 56 patients (90.3%) were presenting with acute cholecystitis and six patients were operated at the onset of acute biliary pancreatitis. The mean operative time was 72.9 min with mean blood loss 45.45 mL.
  
  
  CONCLUSIONS
  The study concluded safety of total clipless laparoscopic cholecystectomy using a harmonic scalpel in Child A and B type cirrhotic patients, who presented with complicated gallstones.
authors.affiliation: Department of Surgery, Gastrointestinal Surgery Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Mohamed I
authors.initials: MI
authors.lastname: Kassem
authors.affiliation: Department of Internal Medicine, Hepatobiliary Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Ehab M
authors.initials: EM
authors.lastname: Hassouna
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D061887:Conversion to Open Surgery; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: cirrhotic patients; clipless laparoscopic cholecystectomy; complicated gallstones; harmonic scalpel