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Updated: Jul 2, 2026
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Retrospective survey on laparoscopic cholecystectomy in the cirrhotic patient
A Cappellani1, B Cacopardo, A Zanghì
1General Surgery and Senology, Department of Surgery, University of Catania, Italy.
Insights
Laparoscopic cholecystectomy (LC) is safe for patients with Child A and B liver cirrhosis. However, Child C patients face higher risks, including increased mortality and complications, necessitating careful surgical evaluation.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Biliary System Diseases
Background:
- Cholelithiasis is prevalent in liver cirrhosis patients due to hemolysis and gallbladder dysfunction.
- Laparoscopic cholecystectomy (LC) is a standard treatment for symptomatic gallstones.
Purpose of the Study:
- To evaluate the safety and outcomes of LC in liver cirrhosis patients across different severity classes (Child A, B, C).
- To compare LC results in cirrhotic patients with historical data from non-cirrhotic patients.
Main Methods:
- Retrospective analysis of 40 cirrhotic patients undergoing LC for symptomatic biliary disease from 1996-2006.
- Data collected included pre-operative, intra-operative, and post-operative parameters.
- Patients were categorized into Child A, B, and C cirrhosis severity groups.
Main Results:
- LC duration, blood loss, and hospital stay increased with cirrhosis severity (Child A < B < C).
- Child A and B patients showed outcomes comparable to non-cirrhotic individuals.
- Child C patients experienced higher mortality (7.5% overall, with 2 deaths) and non-lethal complications.
Conclusions:
- LC is a safe and effective procedure for Child A and B cirrhotic patients with symptomatic gallstones.
- Careful consideration and evaluation are crucial for Child C cirrhotic patients undergoing LC due to increased risks.
- Further research is needed to establish definitive data for Child C cirrhotic patients undergoing LC.
Abstract:
Cholelitiasis is a common disease in patients with liver cirrhosis, mainly due to intravascular haemolysis and functional alterations of the gallbladder. In Child A and B cirrhotics laparoscopic cholecystectomy (LC) demonstrated the same advantages and safety as in the non cirrhotic patients. On the contrary, indications for surgery in Child C patients should be carefully evaluated. Nevertheless, the current number of patients with Child C cirrhosis submitted to LC is too low to extrapolate definitive data. Here we report our observations on a retrospective case series of LCs performed for symptomatic biliary disease in patients affected with liver cirrhosis. Both medical records and surgical registers were used to collect pre-operative, intra-operative and post-operative data from 40 cirrhotics out of 921 patients operated by laparoscopic cholecystectomy between November 1996 and November 2006. All patients underwent LC because of symptomatic disease. The average duration of the laparoscopic intervention was 111 minutes (60-220 minutes) distributed as follows according to the severity of liver disease: 66 minutes (48-87) in the Child A group, 108 minutes (91-119) in the Child B group and 138 minutes (110-160) as refers to Child C cirrhotics. Median blood loss was quantified as 80 ml (28-97) in Child A group, 155 ml (130-180) in Child B group and 300 ml (220-500) among Child C cirrhotics. The median length of hospital stay was 6 days (3-9 days) in the Child A group, 9 days (7-13 days) in the Child B group and 21 days (16-27 days) in Child C cirrhotics. Three cases out of 40 (7,5%) died: 2 Child C and 1 Child B. In conclusion, this study confirms that in patients affected with Child A and B cirrhosis LC may be safely performed either in emergency or in election whereas as refers to Child C cases we have observed a slightly higher mortality but a relevant higher impact of non lethal complications.