Surgical management of gallstones in cirrhotic patients

Among the cirrhotic patients admitted to our department, 64 (17 percent) were found to have cholelithiasis. In 14 patients (22 percent), cholelithiasis caused cholecystitis, obstructive jaundice, or biliary pain. These 14 patients were operated on and underwent cholecystectomy. There was one postoperative complication (gastrointestinal bleeding from esophageal varices) and one death (due to acute respiratory failure). In 50 patients (78 percent) cholelithiasis was asymptomatic. Ten of the 50 patients died from liver failure and the stones were discovered at necropsy. Seven of the patients had radiographically demonstrated stones that were not operated on. They are alive at the present time, more than 2 years later. In the remaining 33 patients, the stones were discovered during portasystemic shunt procedures. In these patients, cholelithiasis was systematically treated by cholecystectomy (8 patients) or cholecystolithotomy (25 patients). Postoperative mortality and morbidity rates were not different in these 33 patients when compared with the rates in 170 patients who underwent portal surgery alone during the same period. Our results confirm the high incidence of cholelithiasis in cirrhotic patients. Complications of gallstones are not frequent but require an emergency operation that carries a high risk in these patients. On the other hand, elective surgical treatment of asymptomatic cholelithiasis at the time of portal diversion does not bear any peculiar risk. In such a situation, cholecystolithotomy is easier and probably safer than cholecystectomy.