Laparoscopic cholecystectomy in cirrhotic patients
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N Leone1, M Garino, P De Paolis
1Department of Gastroenterology, Molinette Hospital, Turin, Italy. leone.nic@tiscalinet.it
Insights
Laparoscopic cholecystectomy is safe for patients with compensated cirrhosis, showing no operative mortality. While complication rates were higher, it remains the preferred treatment over open surgery.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Oncology
Background:
- Symptomatic cholelithiasis is commonly treated with laparoscopic cholecystectomy.
- Cirrhotic patients present unique challenges for surgical procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic cholecystectomy in patients with well-compensated cirrhosis.
- To compare outcomes between cirrhotic patients and a matched control group.
Main Methods:
- A retrospective study comparing 24 cirrhotic patients (Child's class A or B) undergoing laparoscopic cholecystectomy with 72 matched controls.
- Data collected included operative time, blood loss, complication rates, transfusion requirements, and hospital stay.
Main Results:
- No operative mortality in either group.
- Higher postoperative complication rates (20.8% vs. 9.72%) and longer operative times (89.16 vs. 68.41 min) in cirrhotic patients.
- Increased blood loss (106.25 vs. 37.08 ml) and transfusion needs (0.155 vs. 0 units) in the cirrhotic group, with a slightly longer hospital stay (4.7 vs. 3.61 days).
Conclusions:
- Laparoscopic cholecystectomy is a safe and recommended treatment for patients with compensated cirrhosis.
- Laparotomy should be reserved for cases where laparoscopic approach is not feasible or adequate.
Background/Aims:
Laparoscopic cholecystectomy has become the procedure of choice for symptomatic cholelithiasis. A study to evaluate the benefits and risks of laparoscopic cholecystectomy in cirrhotic patients was performed.
Methods:
Between January 1994 and December 2000, 1,100 laparoscopic cholecystectomies for symptomatic gallbladder diseases were performed. There were 24 cirrhotic patients (group A) and 72 age- and sex-matched controls (group B). All patients had well-compensated cirrhosis (Child's class A or B).
Results:
There was no operative mortality in either group and the postoperative complication rates were 20.8 and 9.72% in groups A and B, respectively (p < 0.000001). Operative time in group A was 89.16 vs. 68.41 min in group B (p < 0.000001). The estimated intraoperative blood loss in group A was 106.25 vs. 37.08 ml in group B (p < 0.000001). The average transfusion requirement was 0.155 and 0.0 units in groups A and B, respectively (p < 0.025). The hospital stay in groups A and B was 4.7 and 3.61 days, respectively (p < 0.0500).
Conclusion:
Laparoscopic cholecystectomy in patients with compensated cirrhosis is safe and should be the treatment of choice for these patients. Laparotomy should be applied only if the surgeon considers the operation inadequate to be continued laparoscopically.