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Laparoscopic Cholecystectomy in Cirrhotic Patients
Insights
Laparoscopic cholecystectomy is safe for cirrhotic patients, but higher morbidity occurs in Child-Pugh B and C stages. Perioperative management is key to successful outcomes in these complex cases.
Area of Science:
- Hepatology
- Gastroenterology
- Surgical Oncology
Background:
- Laparoscopic cholecystectomy is the standard for symptomatic gallbladder disease in cirrhosis.
- Assessing morbidity predictors like Child-Pugh score is crucial for patient selection.
Purpose of the Study:
- To evaluate laparoscopic cholecystectomy safety and outcomes in cirrhotic patients.
- To determine the Child-Pugh score's predictive value for morbidity.
Main Methods:
- Retrospective analysis of 111 laparoscopic cholecystectomies in Child-Pugh A, B, and C patients.
- Data collected on intraoperative difficulty, incidents, conversion rates, operative time, and hospital stay.
Main Results:
- 28.8% experienced intraoperative difficulty; 24.3% had intraoperative incidents.
- Morbidity rate was 16.2%, with bleeding and fluid collections more common in Child-Pugh B and C.
- Conversion rate to open surgery was 6.3%.
Conclusions:
- Laparoscopic cholecystectomy is feasible in cirrhotic patients.
- Child-Pugh B and C scores correlate with increased morbidity.
- Effective perioperative management is essential for optimizing results.
Abstract:
Laparoscopic cholecystectomy is the gold standard procedure in patients with cirrhosis and symptomatic gallbladder disease or acute cholecystitis. In this retrospective study we evaluated laparoscopic cholecystectomy in patients with cirrhosis based on Child-Pugh score as a predictor of morbidity. In the First Surgical Clinic of Iasi, from 01 jan 2010 to 31 jan 2020, we performed 111 laparoscopic cholecystectomies in Child-Pugh A, B, and C cirrhotic patients. Intraoperative difficulty (grade 3 Cuschieri) was experienced in 32 patients (28.8%). Highly vascular sub hepatic adherences have been reported in a quarter of all patients. Intraoperative incidents were more frequent 27 (24.3%) compared to laparoscopic cholecystectomy performed in other patient groups. The conversion rate to open cholecystectomy was 6.3% (7 cases). Mean operative time was 84 min. Mean duration of hospitalization stay was 4.7 days. The morbidity rate was 16.2% of patients and included bleeding, intraabdominal fluid collections and wound complications more common in patients with Child-Pugh Cirrhosis B and C. The results are dependent of the perioperative management of the liver function.
