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[Laparoscopic and classic cholecystectomy in patients with liver cirrhosis]
Jaime Poniachik1, Silvia Castro, Ana María Madrid
1Sección de Gastroenterología, Departamento de Cirugía, Instituto de Anatomía Patológica y Departamento de Salud Pública, Hospital Clínico Universidad de Chile, Santos Dumont 999. jponiach@ns.hospital.uchile.cl
Background:
The prevalence of gallstones is increased in patients with cirrhosis. However the presence of cirrhosis has been generally considered a relative contraindication to cholecystectomy.
Aim:
To investigate the complications and the outcomes of laparoscopic and open cholecystectomy in patients with cirrhosis.
Patients And Methods:
Sixty seven patients with gallstones with well-documented cirrhosis undergoing cholecystectomy (laparoscopic cholecystectomy (LC) in 35 and open cholecystectomy (OC) in 32), were studied. The mean age was 57.7 + 10.3 years for LC and 58.9 + 11.6 years for OC. In the LC group, 26 were classified as Child-Pugh class A, 8 as Child's B class and 1 as Child's class C. In the OC group, 12 were classified as Child's class A, 15 as Child's B and 5 as Child's C.
Results:
Complications occurred in 4 of 35 (12.3%) LC patients (1 patients was Child A and 3 were B). In the OC group 14 of 32 patients had complications (4 Child A, 7 B and 3 C, 43.7% p < 0.05 as compared with LC group). Three patients in the OC group died (9.4%). Mean hospital stay was 2.8 + 1.9 and 13 + 12 days in LC and OC patients, respectively (p < 0.05).
Conclusions:
LC has a lower rate of complications than OC and is a reasonable option for Child's class A and B patients with cirrhosis and gallstones.