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Laparoscopic cholecystectomy for patients with cholelithiasis and liver cirrhosis
Hesham Abd Elfattah Rizk1, Abdel Aziz Ali Saleem
1Department of General Surgery, Theodoer Bilharz Research Institute, Imbaba P.O. Box 30, Giza, Egypt.
Insights
Laparoscopic cholecystectomy is safe for cirrhotic patients with Child A and B compensated cirrhosis, but hazardous for Child C. This study evaluated its risks and benefits in symptomatic gallstone patients.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Innovation
- Patient Outcomes
Background:
- Laparoscopic cholecystectomy was historically contraindicated in cirrhotic patients due to poor outcomes with open surgery.
- Symptomatic gallstones in cirrhosis necessitate safe and effective surgical options.
Purpose of the Study:
- To evaluate the outcomes of laparoscopic cholecystectomy in cirrhotic patients with symptomatic gallstones.
- To determine the benefits and risks associated with this procedure in this specific patient population.
Main Methods:
- A comparative study involving 19 cirrhotic patients (GI) and 50 non-cirrhotic controls (GII) undergoing laparoscopic cholecystectomy.
- Classification of cirrhotic patients based on Child-Pugh score (A, B, C) and MELD score.
Main Results:
- Conversion to open surgery occurred in 16% of cirrhotic patients; laparoscopic subtotal cholecystectomy in 11%.
- Postoperative complications included worsened ascites (11%), hepatic encephalopathy (11%), and port site infection (11%).
- Laparoscopic cholecystectomy was deemed safe for Child A and B compensated cirrhosis patients, but hazardous for Child C.
Conclusions:
- Laparoscopic cholecystectomy is a viable and safe option for cirrhotic patients with compensated liver disease (Child A & B).
- Surgical intervention in cirrhotic patients with Child C classification carries significant risks and should be approached with extreme caution.
Abstract:
Cirrhosis was considered an absolute or relative contraindication of laparoscopic cholecystectomy. Open surgery in the cirrhotic patients over-years have witnessed of the poor outcome. The present study evaluated the outcome and determined the benefit and risk of the laparoscopic cholecystectomy in cirrhotic patients with symptomatic gall stone. 19 cirrhotic patients (GI) with symptomatic gall stones and 50 non cirrhotic patients or control (GII) underwent the laparascopic cholecystectomy. Four patients (21%) were Child A, MELD score <10, 13 (68%) were Child B, MELD score 10-15, 2 (11%) were Child C, MELD score >15. 15 patients (79%) had chronic calcular cholecystitis, 4 (21%) with acute on top of chronic calcular cholecystitis. Average operative time was 118 minutes. In 3/19 patients (16%) conversion to the open cholecystectomy was mandatory. Laparoscopic subtotal cholecystectomy was done in 2/19 patients (11%). The main hospital stay and time to resume diet were 5.2 days & 43.3 hours. 3 patients received fresh frozen plasma and/or blood transfusion after surgery. No massive blood transfusion (more than 2 units) was necessary. The postoperative complication occurred in 7 patients (37%), ascites was worsened in 2 (11%), hepatic encephalopathy in 2 (11%), port site infection in 2 (11%) and sub hepatic collection in one patient (5.5%). Laparoscopic cholecystectomy in patients with compensated cirrhosis was safe in those with Child A & B. No reason postponed surgery in them as surgery in patients with Child C was hazardous.