Definitive surgical treatment for cholelithiasis in selected patients with liver cirrhosis

To determine whether definitive surgery such as cholecysectomy or extraction of bile duct stones is appropriate in cirrhotic patients the results of definitive surgery have been reviewed retrospectively in a group of 112 cirrhotic patients with cholelithiasis. Eighty-seven of these patients underwent definitive surgery for gallstones and the remaining 25 were treated conservatively. Child's criteria were applied to each patient. Patients with Child's grade A disease had fewer emergency procedures, operative blood loss and transfusion were less and they had a shorter hospital stay compared with patients with grades B and C. There were 4 deaths after definitive surgery for emergency conditions and these were all in Child's grade C. Of the 83 survivors after definitive procedures 78 patients (93.9%) were still alive 52.8 months later without any biliary tract symptoms. Of the 25 patients undergoing conservative treatment 2 were Child's B and 23 were Child's C grade. We suggest that definitive surgery can be carried out safely, in Child's A and B cirrhotic patients, either electively or as an emergency. However, a more conservative approach is advisable in Child C patients with acute conditions and definitive surgery is recommended as an elective procedure after the liver function has improved.