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[Laparoscopic cholecystectomy of cirrhotic patients]
R Palade1, D Vasile, D Voiculescu
1Spitalul Universitar de Urgenţă Bucureşti Clinica Chirurgie I Splaiul Independenţei nr. 169 Sector 5 Bucureşti. radupalade@yahoo.com
Insights
Laparoscopic cholecystectomy in cirrhotic patients is feasible and safe, despite intraoperative diagnosis in most cases. This gallbladder removal technique offers advantages over open surgery with no recorded complications.
Area of Science:
- Hepatology
- Surgical Gastroenterology
Context:
- Laparoscopic cholecystectomy is a common procedure, but its application in patients with liver cirrhosis presents unique challenges.
- Cirrhosis often leads to coagulopathy and altered anatomy, increasing surgical risks.
Purpose:
- To evaluate the safety and feasibility of laparoscopic cholecystectomy in patients with liver cirrhosis.
- To analyze the diagnostic methods and surgical outcomes in this patient cohort.
Summary:
- Over 9 years, 18 laparoscopic cholecystectomies were performed on cirrhotic patients, with cirrhosis diagnosed intraoperatively in 16 cases.
- Preoperative indicators included patient history, elevated transaminases, low platelet count, and specific ultrasound findings.
- The procedure was challenging in all cases, requiring conversion to open surgery once due to hemorrhage; however, no complications were reported.
Impact:
- Laparoscopic cholecystectomy is a safe and advantageous procedure compared to open surgery, even in cirrhotic patients.
- Findings support the consideration of laparoscopic cholecystectomy in selected cirrhotic patients, with careful preoperative assessment and intraoperative vigilance.
Abstract:
In a period of 9 years in our clinic were performed 18 laparoscopic cholecystectomies (1.5%) at cirrhotic patients. In most of the cases (16) cirrhosis was diagnosed intraoperative. Retrospective, suggestive for a chronic hepatic disease were: patient history (9 cases), transaminases elevations (all cases), low platelet number (8 cases) and some echographic findings (6 cases). Laparoscopic cholecystectomy was difficult in all cases. Conversion to open surgery was necessary in one case because of an important hemorrhage from gallbladder bed. No diseases were recorded. Laparoscopic cholecystectomy is proven as a secure operation and with incontestable advantages comparing to open surgery.
