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Published on: December 4, 2023
A randomized controlled trial of laparoscopic versus open cholecystectomy in patients with cirrhotic portal
Wu Ji1, Ling-Tang Li, Zhi-Ming Wang
1Research Institute of General Surgery, Nanjing General Hospital of Nanjing PLA Command Area, 305 Eastern Zhongshan Road, Nanjing 210002, Jiangsu Province, China.
Insights
Laparoscopic cholecystectomy (LC) is a safe and effective option for patients with cirrhotic portal hypertension (CPH), offering benefits over open surgery. This minimally invasive approach leads to fewer complications and faster recovery for CPH patients.
Area of Science:
- Hepatology
- Surgical Gastroenterology
- Minimally Invasive Surgery
Background:
- Cirrhotic portal hypertension (CPH) presents unique challenges for surgical procedures.
- Gallbladder disease is a common comorbidity in patients with CPH.
Purpose of the Study:
- To evaluate the safety, efficacy, and comparative benefits of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) in patients with CPH.
Main Methods:
- A randomized controlled trial involving 80 patients with symptomatic gallbladder disease and CPH.
- Patients were divided into two groups: LC (42 patients) and OC (38 patients).
- Data on operative outcomes, complications, and recovery were collected and analyzed.
Main Results:
- Laparoscopic cholecystectomy (LC) had a successful conversion rate of 5.3% and comparable operative times to open cholecystectomy (OC).
- LC demonstrated significantly less blood loss (75.5 mL vs. 112.5 mL), a lower postoperative complication rate (13.2% vs. 30.0%), and shorter recovery times (diet resumption and hospitalization).
- No significant difference in operative time was observed between the two groups.
Conclusions:
- Laparoscopic cholecystectomy (LC) is a feasible, relatively safe, and superior alternative to open cholecystectomy (OC) for patients with cirrhotic portal hypertension (CPH).
- Careful attention to surgical technique and perioperative management is crucial for successful LC in CPH patients.
- The benefits of LC include reduced morbidity and faster patient recovery.
Aim:
To evaluate the characters, risks and benefits of laparoscopic cholecystectomy (LC) in cirrhotic portal hypertension (CPH) patients.
Methods:
Altogether 80 patients with symptomatic gallbladder disease and CPH, including 41 Child class A, 32 Child class B and 7 Child class C, were randomly divided into open cholecystectomy (OC) group (38 patients) and LC group (42 patients). The cohorts were well-matched for number, age, sex, Child classification and types of disease. Data of the two groups were collected and analyzed.
Results:
In LC group, LC was successfully performed in 36 cases, and 2 patients were converted to OC for difficulty in managing bleeding under laparoscope and dense adhesion of Calot's triangle. The rate of conversion was 5.3%. The surgical duration was 62.6+/-15.2 min. The operative blood loss was 75.5+/-15.5 mL. The time to resume diet was 18.3+/-6.5 h. Seven postoperative complications occurred in five patients (13.2%). All patients were dismissed after an average of 4.6+/-2.4 d. In OC group, the operation time was 60.5+/-17.5 min. The operative blood loss was 112.5+/-23.5 mL. The time to resume diet was 44.2+/-10.5 h. Fifteen postoperative complications occurred in 12 patients (30.0%). All patients were dismissed after an average of 7.5+/-3.5 d. There was no significant difference in operation time between OC and LC group. But LC offered several advantages over OC, including fewer blood loss and lower postoperative complication rate, shorter time to resume diet and shorter length of hospitalization in patients with CPH.
Conclusion:
Though LC for patients with CPH is difficult, it is feasible, relatively safe, and superior to OC. It is important to know the technical characters of the operation, and pay more attention to the meticulous perioperative managements.
