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Laparoscopic cholecystectomy in patients with early cirrhosis
L Urban1, G A. Eason, S ReMine
1Department of Surgery, Fairview Hospital, Cleveland, Ohio, USA
Insights
Laparoscopic cholecystectomy (LC) is safe for Child
Area of Science:
- Hepatology
- Gastroenterology
- Surgical Innovation
Background:
- Cholecystectomy in cirrhotic patients traditionally reserved for severe biliary disease due to high morbidity and mortality.
- Laparoscopic cholecystectomy (LC) was initially contraindicated in cirrhotic patients owing to portal hypertension and coagulopathy concerns.
Purpose of the Study:
- To evaluate the safety and feasibility of laparoscopic cholecystectomy (LC) in patients with Child's class A cirrhosis.
Main Methods:
- Retrospective review of cirrhotic patients who underwent cholecystectomy between 1990 and 1998.
- Analysis focused on Child's class A patients undergoing laparoscopic cholecystectomy (LC).
Main Results:
- Fifteen Child's class A cirrhotic patients underwent LC with no intraoperative or postoperative complications.
- No blood transfusions were required, and no deaths occurred.
- Postoperative stay was short, with 3 days or less for most patients.
Conclusions:
- Laparoscopic cholecystectomy (LC) can be performed safely in patients with Child's class A cirrhosis.
- Findings suggest LC is a viable option, challenging previous contraindications for this patient group.
Abstract:
Traditionally, cholecystectomy in cirrhotic patients has been reserved for patients with severe biliary disease, because of the high morbidity and mortality in cirrhotic patients undergoing this procedure. Laparoscopic cholecytectomy (LC) was originally contraindicated in cirrhotic patients because of the associated portal hypertension and coagulopathy. This study examined the safety of LC in Child's class A patients.A review was conducted of all patients with cirrhosis who underwent cholecystectomy at our hospital between 1990 and 1998.Fifteen patients with cirrhosis had their gallbladder removed laparoscopically during that time period. All patients were Child's class A. The average age was 59 (range, 36-85). The operative indications included acute cholecystitis (5 patients), biliary pacreatitis (4 patients), biliary colic (5 patients), and cholangitis (1 patients). Six patients had known cirrhosis, and 9 were examined intraoperatively. The average operative time was 105 minutes. None of the patients required a blood transfusion. No intraoperative or postoperative complications occurred. No deaths occurred. Postoperative stay was 3 days or less in all but 3 patients.These results compare favorably to other published studies from outside of the United States. Based on our findings, we believe LC can be performed safely in patients with class A cirrhosis.