Cirrhosis is not a contraindication to laparoscopic cholecystectomy: results and practical recommendations
Kevin Tri Nguyen1, Krit Kitisin, Jennifer Steel
1Division of Transplantation, University of Pittsburgh, Pittsburgh, PA, USA.
Insights
Laparoscopic cholecystectomy is a safe and effective procedure for patients with cirrhosis, particularly those with Child-Pugh class A. This approach offers reduced complications and shorter hospital stays compared to open surgery.
Area of Science:
- Hepatology
- Surgical Gastroenterology
Background:
- Gallstones are common in cirrhosis patients, with open cholecystectomy posing high risks.
- Laparoscopic cholecystectomy is evaluated as an alternative in this high-risk group.
Purpose of the Study:
- To assess the safety and efficacy of laparoscopic cholecystectomy in patients with cirrhosis.
- To provide management recommendations for cirrhotic patients undergoing cholecystectomy.
Main Methods:
- Retrospective review of 68 patients with cirrhosis undergoing laparoscopic cholecystectomy (March 1999-May 2008).
- Subgroup analysis based on Child-Pugh's classes A, B, and C.
Main Results:
- Laparoscopic cholecystectomy was feasible in cirrhotic patients, with 69% being Child-Pugh class A.
- Patients with Child-Pugh class A experienced significantly shorter operative times, less blood loss, fewer conversions to open surgery, and shorter hospital stays.
Conclusions:
- Laparoscopic cholecystectomy is a viable option for patients with cirrhosis.
- The procedure demonstrates low morbidity and no mortality, especially in Child-Pugh class A patients.
Background:
Gallstones appear more frequently in patients with cirrhosis and open cholecystectomy in this patient population is associated with higher morbidity and mortality. The aim of the present study was to evaluate experience with laparoscopic cholecystectomy in patients with cirrhosis and to provide recommendations for management.
Methods:
Retrospective review of laparoscopic cholecystectomy in patients with cirrhosis from March 1999 to May 2008 was performed. Peri-operative characteristics and subgroup analysis were performed in patients with Child-Pugh's classes A, B and C cirrhosis.
Results:
A total of 68 patients were reviewed in this study. In all, 69% of the patients were Child's class A. The most common indication for cholecystectomy was chronic/symptomatic cholelithiasis (68%). Compared with patients with Child's class B and C, laparoscopic cholecystectomy in patients with Child's class A was associated with significantly decreased operative time (P= 0.01), blood loss (P= 0.001), conversion to open cholecystectomy (P= 0.001) and length of hospital stay (P= 0.001).
Conclusions:
Laparoscopic cholecystectomy in patients with cirrhosis is feasible with no mortality and low morbidity, especially in patients with Child's class A cirrhosis.
