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Application of laparoscopic cholecystectomy in patients with cirrhotic portal hypertension
Wu Ji1, Ling-Tang Li, Xun-Ru Chen
1Research Institute of General Surgery of PLA, Nanjing General Hospital of Nanjing PLA Command, Nanjing 210002, China.
Insights
Laparoscopic cholecystectomy is feasible and relatively safe for patients with cirrhotic portal hypertension, despite technical challenges. Meticulous surgical technique and perioperative care are key to successful outcomes.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Innovation
- Patient Safety in Cirrhosis Management
Background:
- Laparoscopic cholecystectomy (LC) is standard for gallbladder disease, but its use in cirrhotic portal hypertension (CPH) is less documented.
- CPH was historically a contraindication for LC due to potential risks.
- Recent trends show increased LC use in cirrhosis, necessitating evaluation in CPH patients.
Purpose of the Study:
- To assess the feasibility, safety, and technical aspects of LC in patients with CPH.
- To document the outcomes of LC in a cohort of CPH patients with symptomatic gallbladder disease.
Main Methods:
- Retrospective analysis of perioperative data from 38 patients with symptomatic gallbladder disease and CPH.
- Patients were classified by Child class (A, B, C) to evaluate outcomes across disease severity.
Main Results:
- Successful LC in 36 of 38 patients (94.7%); 2 conversions to open cholecystectomy (OC).
- Average surgical time was 62.6 minutes with minimal blood loss (75.5 ml); no transfusions needed.
- Postoperative complications occurred in 13.2% of patients, with all recovering fully.
Conclusions:
- LC is a feasible and relatively safe option for select CPH patients with symptomatic gallbladder disease.
- Surgeons require specific technical knowledge and diligent perioperative management for successful LC in CPH.
- Careful patient selection and surgical expertise are crucial for minimizing risks and optimizing outcomes.
Background:
Laparoscopic cholecystectomy (LC) has been widely adopted in treating benign gallbladder diseases. Cirrhosis and cirrhotic portal hypertension (CPH) are contraindicated for LC in its early period. In recent years, several studies have reported liberal use of LC in patients with cirrhosis. But its benefits and successful use in patients with CPH are less documented. This study was designed to evaluate the feasibility, safety and technical characteristics of LC in CPH patients.
Methods:
In 38 patients with symptomatic gallbladder disease and CPH, 19 belonged to Child A class, 15 Child B class and 4 Child C class. Perioperative data of these patients were collected and analyzed.
Results:
LC was successfully performed in 36 patients, and 2 patients (5.3%) were converted to open cholecystectomy (OC) for difficulty in management of bleeding under laparoscopy and dense adhesion of Calot's triangle. The surgical time was 62.6+/-15.2 minutes. The estimated amount of intraoperative hemorrhage was 75.5+/-15.5 ml. No blood transfusion was necessary. The time to resume diet was 18.3+/-6.5 hours. Seven postoperative complications in 5 patients (13.2%) included port-site infection (1 patient), respiratory infection (2), upper digestive tract bleeding (1), slight hepatic encephalopathy (1) and increased ascites (2). All patients were cured and discharged from the hospital within 5.6+/-2.4 days after LC.
Conclusions:
Despite LC is difficult for CPH patients, it is feasible and relatively safe. To make LC successful in patients with CPH, it is necessary for surgeons to acquaint with the technical characteristics of LC and emphasize meticulous perioperative management.