Laparoscopic cholecystectomy in cirrhotic patients: feasibility in a developing country

Although laparoscopic cholecystectomy (LC) has become the procedure of choice for cholelithiasis in the general population, many consider cirrhosis as a relative or absolute contraindication for laparoscopic surgery. The aim of this study was to confirm the safety of LC in cirrhotic patients in our set-up.

This is a retrospective case series including all the patients with cirrhosis who underwent LC for gallstones from January 2000 to December 2006 at our institution. Data were analyzed for Child class, indication for surgery, hospital stay, and procedure-related morbidity and mortality. Results are given as mean +/- standard deviation.

Thirty patients, including 21 females (median age: 42 years) underwent LC during the study period. There was no operative mortality. Twenty-four patients belonged to Child class A and 6 belonged to Child class B. Mean operative time was 80 +/- 26 min. There was no incidence of bile duct injury, but two patients (6.7%) required conversion to open procedure. Mean hospital stay was 3 +/- 2.7 days. Postoperative morbidity was observed in seven patients, including postoperative deterioration of liver function in 2, worsening of ascites in 2 and pneumonia, and port-site infection in 1. Two patients had significant drop in hemoglobin requiring blood transfusion.

Cirrhosis is not a contraindication for LC and it can be performed safely in compensated cirrhotic patients with acceptable morbidity and mortality.