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A metaanalysis of laparoscopic cholecystectomy in patients with cirrhosis
Alessandra Puggioni1, Linda L Wong
1University of Hawaii John A Burns School of Medicine, Honolulu, HI, USA.
Insights
Laparoscopic cholecystectomy (LC) in patients with cirrhosis shows higher complication rates but offers benefits like reduced blood loss and shorter hospital stays compared to open surgery. Further research is needed for Child-Pugh class C patients.
Area of Science:
- Hepatology
- Surgical Gastroenterology
- Minimally Invasive Surgery
Background:
- Limited research exists on laparoscopic cholecystectomy (LC) in patients with cirrhosis.
- Existing studies are retrospective with small sample sizes, hindering definitive conclusions.
Purpose of the Study:
- To synthesize existing literature on LC in patients with cirrhosis.
- To compare outcomes of LC versus open cholecystectomy in cirrhotic patients.
- To evaluate complications and indications for LC in this patient group.
Main Methods:
- An extensive literature search was performed using Medline, Embase, and Cochrane databases.
- Keywords included "laparoscopic cholecystectomy" and "cirrhosis" or "cirrhotic".
- Data from 25 publications (1993-2001) involving 400 patients were extracted and analyzed.
Main Results:
- Patients with cirrhosis undergoing LC had higher conversion rates, operative times, bleeding complications, and overall morbidity compared to those without cirrhosis.
- Acute cholecystitis was more prevalent in cirrhotic patients.
- LC in cirrhotic patients was associated with less operative blood loss, shorter operative time, and reduced hospital stay compared to open cholecystectomy.
Conclusions:
- Cirrhotic patients undergo cholecystectomy for more emergent reasons and experience higher morbidity.
- The laparoscopic approach provides advantages in blood loss, operative time, and hospitalization duration for patients with cirrhosis.
- Prospective studies are required to determine factors affecting outcomes and the appropriateness of LC in Child's-Pugh class C cirrhosis.
Background:
Few articles address the issue of LC in patients with cirrhosis. Existing articles are retrospective and with small sample sizes, which makes it difficult to draw conclusions about indications and complications with LC in this setting.
Study Design:
An extensive search of the Medline, Embase, and Cochrane databases using the terms "laparoscopic cholecystectomy" and "cirrhosis" or "cirrhotic" was conducted. The data from each study were extracted, combined with those of similar studies, and analyzed.
Results:
Twenty-five publications (400 patients with cirrhosis undergoing LC) from 1993 to 2001 were identified. Four articles compared LC with open cholecystectomy in patients with cirrhosis, and six compared patients with cirrhosis to patients without cirrhosis. Patients were primarily in Child-Pugh class A or B, with only six patients in Child-Pugh class C. Compared with patients without cirrhosis, patients with cirrhosis had higher conversion rates (7.06% versus 3.64%, p = 0.024), operative times (98.2 minutes versus 70 minutes, p = 0.005), bleeding complications (26.4% versus 3.1%, p < 0.001), and overall morbidity (20.86% versus 7.99%, p < 0.001). Acute cholecystitis was evident in 47% of patients with cirrhosis versus 14.7% of patients without cirrhosis (p < 0.001). When LC was compared with open cholecystectomy in patients with cirrhosis, LC was associated with less operative blood loss (113 mL versus 425.2 mL, p = 0.015), operative time (123.3 minutes versus 150.2 minutes, p < 0.042), and length of hospital stay (6 days versus 12.2 days, p < 0.001).
Conclusions:
Patients with cirrhosis undergo cholecystectomies for more emergent reasons and have higher morbidity. The laparoscopic approach offers advantages of less blood loss, shorter operative time, and shorter length of hospitalization in patients with cirrhosis. Prospective studies will establish which factors affect outcomes and determine the appropriateness of LC in Child's-Pugh class C cirrhosis.
