Related Experiment Videos
Insights
Cholecystectomy in cirrhotic patients is risky but manageable. This study found no deaths in seven cirrhotic patients undergoing biliary surgery, suggesting improved outcomes are possible with careful management.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Transplant Surgery
Background:
- Cholecystectomy is a common and generally safe general surgery procedure.
- Gallstone disease (cholelithiasis) incidence is doubled in patients with liver cirrhosis.
- Biliary surgery in cirrhotic patients poses significant risks, mainly due to excessive bleeding.
Purpose of the Study:
- To review the outcomes of biliary surgery in cirrhotic patients.
- To identify factors influencing operative outcomes in this high-risk group.
Main Methods:
- Retrospective review of seven consecutive cirrhotic patients undergoing biliary surgery.
- Analysis of intraoperative blood loss and correlation with preoperative prothrombin times.
Main Results:
- No mortality was observed in the seven reviewed cirrhotic patients.
- Intraoperative blood loss showed a correlation with preoperative prothrombin times.
- Five patients required blood transfusions during the procedure.
Conclusions:
- Biliary surgery in cirrhotic patients can be performed without mortality.
- Preoperative prothrombin time is a key indicator of potential blood loss.
- Careful management and consideration of specific factors can improve surgical outcomes in cirrhotic patients.
Abstract:
Cholecystectomy is the most common intraperitoneal operation done by general surgeons in this country and is generally considered safe. The incidence of cholelithiasis is doubled among cirrhotic patients, and biliary surgery in such patients carries tremendous risk, primarily due to excessive intraoperative hemorrhage. One author has reported a mortality of 83% among patients with severe cirrhosis having cholecystectomy. In this report, we review seven consecutive cirrhotic subjects having biliary surgery. There were no deaths. Blood loss roughly correlated with preoperative prothrombin times. Blood transfusions were required in five patients. Factors believed to improve operative outcome are discussed.