Cirrhosis and laparoscopic cholecystectomy

Although cirrhosis has been regarded as a contraindication to laparoscopic cholecystectomy, there is increasing evidence that patients with mild to moderate cirrhosis may safely undergo laparoscopic cholecystectomy with results superior to those of open cholecystectomy. A prospective evaluation and comparison of outcome in 25 consecutive patients with cirrhosis and 1275 patients without cirrhosis undergoing laparoscopic cholecystectomy was undertaken. Fourteen patients with Child's A cirrhosis, nine with Child's B, and two with Child's C underwent laparoscopic cholecystectomy. After surgery, one patient with Child's C cirrhosis died. The median length of stay was 4 days. Postoperative morbidity occurred in 52% of patients and included hemorrhage (8%), thromboembolism (4%), wound complications (24%), intraabdominal collections (12%), and cardiopulmonary complications (8%). Major comorbidity was present in 60% of patients and contributed to complication rate and prolonged stay. Hemorrhage (P = 0.04) and wound complications (P = 0.02) occurred more frequently in patients with cirrhosis than in patients without cirrhosis. Laparoscopic cholecystectomy in patients with cirrhosis is associated with significant but acceptable morbidity and mortality rates, and complications are frequently related to comorbid conditions.