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Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Elective cholecystectomy in selected cirrhotic patients
C Iannuzzi1, G Cozzolino, G Negro
1Institute of General and Geriatric Surgery, Università di Napoli Federico II, Italy.
Insights
Elective cholecystectomy is safe for selected cirrhotic patients with gallstones. This surgery, for symptomatic individuals with good liver function, showed no mortality in this study.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Oncology
Background:
- Cholelithiasis (gallstones) is a common condition, particularly in patients with liver cirrhosis.
- The management of gallstones in cirrhotic patients presents unique challenges due to impaired liver function and increased surgical risk.
Purpose of the Study:
- To evaluate the safety and outcomes of elective cholecystectomy in patients with liver cirrhosis and symptomatic cholelithiasis.
- To identify risk factors for complications and determine the feasibility of surgical intervention in this patient population.
Main Methods:
- Retrospective analysis of 53 cirrhotic patients with cholelithiasis observed between 1978 and 1991.
- 31 patients underwent elective cholecystectomy, with or without common bile duct exploration.
- Patient selection was based on symptomatic presentation and assessment of hepatic functional reserve (Child-Pugh classification).
Main Results:
- No mortality was observed among the 31 surgically treated patients.
- The most frequent non-lethal complication was hemorrhage from the gallbladder bed, associated with prolonged prothrombin time and low platelet count.
- Common bile duct exploration was linked to an increased risk of bleeding. Two patients with advanced cirrhosis (Child-Pugh B or C) developed ascites.
Conclusions:
- Elective cholecystectomy can be performed safely in selected symptomatic cirrhotic patients with adequate hepatic functional reserve.
- Careful patient selection and management of coagulopathy are crucial for minimizing surgical risks.
- Further research may explore refined surgical techniques and perioperative management strategies for this group.
Abstract:
Of the 53 cirrhotic patients with cholelithiasis observed at our Institution from 1978 to 1991, 31 were operated on. Twenty-eight Child-Pugh class A, two class B and one class C patients underwent elective cholecystectomy with (5 cases) or without (26 cases) common bile duct exploration. Among the symptomatic patients, nine (18.7%) were refused for surgery because the risk was estimated to be too high. Symptoms ranged from mild-moderate abdominal pain to typical biliary colic. Acute biliary inflammatory complications as cholecystitis or cholangitis could be detected in the clinical history of 5 patients (16%). Although a common clinical feature, jaundice was directly related to gallbladder or common bile duct stones only in one half of the cases. A total of 18 postoperative non-lethal complications occurred in ten patients (32.2%), with haemorrhage from the gallbladder bed being the most frequent event. Bleeding was associated with increased prothrombin time more than 1.5 seconds above the control (p < 0.01) but severe haemorrhage occurred only when the platelet count was less than 100.000/ml (p < 0.05). Common bile duct explorations increased the risk of bleeding. Two of the 3 class B or C patients developed ascites (p < 0.05). It is concluded that elective cholecystectomy can be performed without mortality in selected and symptomatic patients with adequate hepatic functional reserve.
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