Laparoscopic Cholecystectomy in Cirrhotic Patients (original) (raw)
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Laparoscopic Cholecystectomy in Patients With Cirrhosis of the Liver and Symptomatic Cholelithiasis
Jsls Journal of the Society of Laparoendoscopic Surgeons Society of Laparoendoscopic Surgeons, 2009
Background: Laparoscopic cholecystctomy has become the treatment of choice for symptomatic gallstones. The potential risks have dissuaded some surgeons from using the laparoscopic procedure in patients with previous abdominal surgery. Therefore, we aimed to investigate the effect of previous abdominal surgery on the feasibility and safety of laparoscopic cholecystectomy.
LAPAROSCOPIC CHOLECYSTECTOMY IN CIRRHOTIC PATIENTS WITH SYMPTOMATIC GALLSTONE DISEASE
ANZ Journal of Surgery, 2008
The aim of this study was to evaluate the outcome in patients with liver cirrhosis who underwent laparoscopic cholecystectomy for symptomatic gallstone disease. Retrospective analysis of prospectively collected data of 34 patients operated between March 1998 and April 2006. There were 19 male and 15 female patients with a median age of 62 years. Cirrhosis aetiology was viral hepatitis in 25 patients, alcohol in 6, primary biliary cirrhosis in 2 and in 1 patient the cause was not identified. Twenty-three were classified as Child-Pugh-Turcotte stage A and 11 as Child-Pugh-Turcotte stage B. The median Model For End-Stage Liver Disease score was 12. Median operating time was 96 min. In three patients there was conversion to open cholecystectomy. Postoperatively, one patient died and six more patients had complications. Median postoperative stay was 3 days. Patients with acute cholecystitis did not have increased morbidity, but had significantly longer hospital stay. Laparoscopic cholecystectomy can be carried out with acceptable morbidity in selected patients with well-compensated Child A and B stages liver cirrhosis. Patients with evidence of significant portal hypertension and severe coagulopathy should avoid surgery.
Outcome of laparoscopic cholecystectomy for gallstones disease in patients with liver cirrhosis
Journal of Ayub Medical College, Abbottabad : JAMC
Laparoscopic cholecystectomy (LC), a gold standard procedure for cholelithiasis, is associated with higher incidence of bile duct injuries and perioperative bleeding. These complications are of further concern when LC is carried out on patients with liver cirrhosis. Although LC is now increasingly being performed for cholelithiasis in cirrhotic patients, the safety of the procedure is debatable in this group of patients. We retrospectively analysed 82 LCs, performed between January 2002 and December 2011. in cirrhotic patients with gall stone disease for perioperative complications. Patients were sub-classified into Class A, B and C based on child-Pugh classification of severity of liver cirrhosis. Intergroup comparisons were carried out using ANOVA, and p < or = 0.05 was considered significant. LC was successfully completed in all but 3 patients (3.7%). None of the cirrhotic patients had bile duct injury. Class C patients (n = 27) had higher frequency of perioperative bleeding t...
Laparoscopic Cholecystectomy in Cirrhotic Patient
HPB Surgery, 1996
Cholecystectomy is associated with increased risk in patients with liver cirrhosis. Moreover, cirrhosis and portal hypertension have been considered relative or absolute contraindication to laparoscopic cholecystectomy. As experience with laparoscopic cholecystectomy increased, we decided to treat cirrhotic patients via this approach. Between January 1994 and April 1995, nine patients with a Child-Pugh's stage A cirrhosis underwent elective laparoscopic cholecystectomy with intraoperative cholangiography. There was no significant per- or post-operative bleeding and no blood transfusion was necessary. There was no mortality and very low morbidity. Median hospital stay was 3 days. This series suggests that wellcompensated cirrhosis can not be considered a contraindication to laparoscopic cholecystectomy.
Laparoscopic cholecystectomy and cirrhosis: patient selection and technical considerations
Annals of Laparoscopic and Endoscopic Surgery
The incidence of cholelithiasis in cirrhotic patients is higher than in general population. In the past, open cholecystectomy (OC) was the standard approach for patients requiring cholecystectomy. However, laparoscopic cholecystectomy (LC) was introduced in 1980's and gradually became the preferred technique even to cirrhotic patients. The performance of gastrointestinal surgery procedures in cirrhotics patients is well-known to be associated with higher technical difficulty and increased morbidity-mortality. Cirrhosis is a major key intraoperative finding that contributes to surgical difficulty in LC. Model of End Stage Liver Disease (MELD) score and Child-Pugh Classification are the best devices to evaluate the underlying liver disease and to predict morbidity-mortality. Acute cholecystitis has higher incidence in patients with cirrhosis, emergency procedures in cirrhotics patients are associated with higher morbidity, longer postoperative hospitalization and a seven-fold higher mortality in comparison to elective surgery. LC in cirrhotics has a higher conversion rate to open procedure; however, LC demonstrated substantial advantage over OC providing shorter convalescence period and hospital stay.
Evaluation of laparoscopic cholecystectomy in cirrhotic patients
Ain Shams Journal of Surgery
Background: Traditionally cholecystectomy in cirrhotic patients is restricted to severe biliary disease, because of high morbidity and mortality following the procedure. Laparoscopic cholecystectomy (LC) was originally contraindicated in cirrhotic patients because of associated portal hypertension and coagulopathy. Patients and methods: Fifty cirrhotic patients underwent LC in Ain Shams University Hospital from January 2007 till December 2008. Results: There were no mortalities in our group. Mean age was 45.6 years and mean operative time was 74.5 min. Conversion to open cholecystectomy occured in 12 patients (24%). Postoperative complications occurred in 9 patients (18%). Mean hospital stay was 3.4 days in Child A and 6.8 days in Child B. Conclusion: Laparoscopic cholecystectomy can be performed safely in cirrhotic patients with well compensated liver functions.
Comparative study between laparoscopic and open cholecystectomy in cirrhotic patients
Al-Azhar International Medical Journal (Print), 2022
Background: Gallstones are twice as common in cirrhotic patients as in the normal population. When gallbladder stones are symptomatic in cirrhotic people , they are linked to higher rates of morbidity and death than in non-cirrhotic people. Aim of the work: To compare open cholecystectomy versus laparoscopic cholecystectomy in cirrhotic patients.
Assessment of Feasibility and Complications of Laparoscopic Cholecystectomy in Cirrhotic Patients
Asian Journal of Pharmaceutical and Clinical Research
Introduction: From the era of absolute contraindication to the phase of preferred treatment, the technique of laparoscopic cholecystectomy advances with time. Here, we report our experience of laparoscopic cholecystectomy in 20 patients with liver cirrhosis. In our institute, laparoscopic cholecystectomy is the preferred choice for cholelithiasis in cirrhotic patient. Methods: In past 2 years, 180 laparoscopic cholecystectomies were performed and 20 patients were cirrhotic. Their data analyzed retrospectively in terms of pre-operative optimization, operative technique and results. Results: Laparoscopic cholecystectomy was completed successfully in 19 patients and one was converted to open. Mean operative time was 54 minutes. No additional port was required in all cases. Calot's first dissection was performed in 18 patients and fundus first technique was used in two patients due to unclear anatomy. Liver bed bleeding was present in 16 patients, which was controlled effectively. Subhepatic drain was placed in 12 patients. There was no mortality. Morbidity in two patients was worsening of ascites in one; incisional hernia in other patient which was converted to open. Port site complications were not noted in any patient, and there was no evidence of intraabdominal bleeding or bile leak postoperatively. Blood and component transfusion was required in two patients. Average length of hospital stay was 4.8 days. Conclusion: Although laparoscopic cholecystectomy may be difficult in cirrhotic patients, it is feasible and relatively safe. It offers many advantages in cirrhotic patients and associated with low morbidity when compared with open surgery.
Background: Gallstones are more common in patients with liver cirrhosis than in healthy individuals. Higher morbidity and mortality were reported in cirrhotic patients with either laparoscopic or open cholecystectomy. The aim of this study was to compare laparoscopic and open cholecystectomy in cirrhotic patients with symptomatic cholelithiasis in a prospective, randomized manner. Materials and Methods: Thirty patients with symptomatic cholelithiasis associated with Child-Pugh class A or B liver cirrhosis were prospectively and randomly grouped equally to either laparoscopic or open cholecystec-tomy. The two groups were compared regarding operative time, morbidity, mortality, postoperative liver function, and hospital stay. Results: The two groups were comparable regarding demographic data, preoperative and postoperative Child-Pugh scoring, mean operative time (57.3 minutes for laparoscopic and 48.5 for open), and complications (33.3% for each). Hospital stay was shorter for the laparoscopic group. One conversion (6.7%) to open surgery was reported. No periopertive mortality occurred in either group. Conclusions: For Child-Pugh class A and B cirrhotics, laparoscopic cholecystectomy is comparable to the open approach regarding operative time, morbidity, mortality, and effect on liver function, but with shorter hospital stay. Considering the other well-documented advantages of the laparoscopic approach, namely, less pain, earlier mobilization and feeding, and better cosmoses, laparoscopic cholecystectomy would be the first choice in cirrhotic patients.