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Related Experiment Videos

Laparoscopic cholecystectomy in cirrhotics.

Norman Oneil Machado1

  • 1Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman. oneilnorman@gmail.com

JSLS : Journal of the Society of Laparoendoscopic Surgeons
|January 16, 2013
PubMed
Summary

Laparoscopic cholecystectomy (LC) is safe for patients with liver cirrhosis (Child-Pugh classes A and B), showing acceptable morbidity and conversion rates. Specialized techniques can manage challenges in this patient group.

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Area of Science:

  • Hepatology
  • Gastroenterology
  • Surgical Oncology

Background:

  • Liver cirrhosis is often a contraindication for laparoscopic cholecystectomy (LC) due to concerns about complications.
  • This review examines approaches to performing LC in cirrhotic patients, a technically demanding procedure.

Purpose of the Study:

  • To review the literature on laparoscopic cholecystectomy in patients with liver cirrhosis.
  • To identify safe approaches and outcomes for this patient population.

Main Methods:

  • A Medline search identified 1310 cases of LC in cirrhotic patients from 1994-2011.
  • A meta-analysis compared outcomes of LC in 400 cirrhotic patients versus non-cirrhotic patients.

Main Results:

  • Overall conversion rate was 4.58%, morbidity 17%, and mortality 0.45%.
  • Cirrhotic patients had higher conversion rates, longer operative times, and increased bleeding and overall morbidity compared to non-cirrhotic patients.
  • Techniques like ultrasonic shears and subtotal cholecystectomy improved safety.

Conclusions:

  • Laparoscopic cholecystectomy is feasible and safe for cirrhotic patients in Child-Pugh classes A and B.
  • Acceptable morbidity and conversion rates can be achieved with appropriate techniques.

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