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Laparoscopic cholecystectomy in cirrhotic patients
L A D'Albuquerque1, M P de Miranda, T Genzini
1Liver Therapy Center (CETEFI), Hospital Beneficência, Portuguesa, São Paulo, Brazil.
Insights
Laparoscopic cholecystectomy is a safe procedure for selected patients with cirrhosis (Child A and B). This study found no mortality or need for open surgery, with minimal complications in these patients.
Area of Science:
- Hepatology
- Surgical Gastroenterology
Background:
- Cholecystectomy in patients with cirrhosis typically leads to high morbidity and mortality.
- Selecting appropriate patients is crucial for improving surgical outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic cholecystectomy in cirrhotic patients.
- To determine complication and mortality rates associated with the procedure in this population.
Main Methods:
- Laparoscopic cholecystectomy was performed on 12 cirrhotic patients (eight Child A, four Child B).
- Patient demographics, operative details, and postoperative outcomes were recorded.
- Intraoperative cholangiography was utilized in select cases.
Main Results:
- No mortality or need for laparotomy was observed.
- Only one patient (8.3%) required a blood transfusion.
- Four patients experienced minor, easily managed postoperative complications (e.g., renal failure, wound issues).
- No instances of postoperative liver failure occurred.
Conclusions:
- Laparoscopic cholecystectomy is a safe and well-tolerated procedure for carefully selected cirrhotic patients (Child A and B) with a clear surgical indication.
- The study demonstrates favorable outcomes, including low complication and no mortality rates.
Abstract:
Cholecystectomy in cirrhotic patients is commonly followed by high morbidity and mortality. In our study, laparoscopic cholecystectomy was performed in 12 cirrhotic patients (eight Child A and four Child B) in an effort to obtain lower complication and mortality rates. The mean age of the group was 51.8 years; seven of the 12 patients were men. Four patients had liver disease from virus B, five from virus C, one because of alcohol, and two had cryptogenic liver cirrhosis. The average operative time was 157 min. Intraoperative cholangiography could be performed in eight cases. No mortality or need to perform laparotomy occurred. Only one patient required blood transfusion (8.3%). Postoperative complications occurred in four patients, but these were easily controlled and included renal failure, diabetic impairment, hematoma with ascitic leakage through the wound, and wound abscess, one case each. No postoperative liver failure was observed. All patients walked and were refed in the first 24 h after surgery. They were dismissed in an average period of 2.5 days. Our primary view demonstrated that laparoscopic cholecystectomy was safe and well tolerated by selected cirrhotic patients (Child A and B) with clear indication for surgery.