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Published on: February 28, 2025
Laparoscopic cholecystectomy in Child-Pugh class C cirrhotic patients
Giuseppe Currò1, Giuliano Iapichino, Giuseppinella Melita
1Department of Human Pathology, University of Messina, Messina, Italy. jose.c@tiscali.it
Insights
Laparoscopic cholecystectomy is safe for Child-Pugh A and B cirrhosis patients. However, it poses high risks for Child-Pugh C patients, suggesting alternative treatments like percutaneous drainage.
Area of Science:
- Hepatology
- Gastroenterology
- Surgical Oncology
Background:
- Symptomatic cholelithiasis is common in patients with cirrhosis.
- Child-Pugh classification is crucial for assessing liver function and surgical risk.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic cholecystectomy in cirrhotic patients.
- Specifically assess outcomes in Child-Pugh C patients with symptomatic gallstones.
Main Methods:
- Retrospective review of 42 laparoscopic cholecystectomies (1995-2004).
- Analysis focused on 4 Child-Pugh C patients, comparing them to 38 Child-Pugh A/B patients.
Main Results:
- Child-Pugh A/B patients: 0 deaths, 26% morbidity (hemorrhage, infection, etc.), 5-day mean stay.
- Child-Pugh C patients: 50% mortality (liver failure, sepsis), 75% morbidity (including bleeding requiring reoperation), 10-day mean stay.
Conclusions:
- Laparoscopic cholecystectomy is safe for well-selected Child-Pugh A/B cirrhotic patients.
- It is a high-risk procedure for Child-Pugh C patients, necessitating careful indication evaluation.
- Percutaneous gallbladder drainage may be a safer alternative for Child-Pugh C patients.
Objectives:
This study aimed to determine whether laparoscopic cholecystectomy is a safe and advisable procedure in Child-Pugh C cirrhotic patients with symptomatic cholelithiasis.
Methods:
The records of 42 laparoscopic cholecystectomies performed between January 1995 and February 2004 in patients with Child-Pugh A, B, and C cirrhosis were retrospectively reviewed, focusing on the 4 patients with Child-Pugh C cirrhosis.
Results:
Among the 38 Child-Pugh A and B patients, no deaths occurred. In this group, only 1 Child-Pugh B cirrhotic patient required blood transfusion, and postoperative morbidity occurred in 10 patients including hemorrhage, wound infection, intraabdominal collection, and cardiopulmonary complications (morbidity rate 26%). The mean postoperative stay was 5 days (range, 3 to 13). The indication for surgery in the 4 Child-Pugh C patients was acute cholecystitis. In this group, 2 deaths occurred for severe liver failure in 1 case and for sepsis in the other. One patient developed heavy gallbladder bed bleeding, and a second operation was necessary to control the hemorrhage. The morbidity rate was 75%. Only 1 patient had no complications. The mean postoperative stay was 10 days (range, 4 to 17).
Conclusions:
Laparoscopic cholecystectomy is a safe procedure in well-selected Child-Pugh A and B cirrhotic patients indicated for surgery, but it is a very high-risk procedure in Child-Pugh C patients. Indications for surgery in Child-Pugh C patients should be evaluated very carefully and surgery should be avoided unless the patient needs an emergency cholecystectomy for acute cholecystitis. Child-Pugh C cirrhotic patients might better benefit from percutaneous drainage of the gallbladder.
