Meta-analysis of laparoscopic versus open cholecystectomy for patients with liver cirrhosis and symptomatic cholecystolithiasis (original) (raw)
Related papers
HPB, 2012
Background/aim: To assess the impact of open versus laparoscopic surgery in cirrhotic patients undergoing a cholecystectomy using the Nationwide Inpatient Sample (NIS). Methods: All patients with cirrhosis who underwent a cholecystectomy (open or laparoscopic) between 2003 and 2006 were queried from the NIS. Associated complications including infection, transfusion, reoperation, liver failure and mortality were determined. Results: A total of 3240 patients with cirrhosis underwent a cholecystectomy: 383 patients underwent an open cholecystectomy (OC) whereas 2857 patients underwent a laparoscopic cholecystectomy (LC), which included 412 patients converted (LCC) from a LC to an OC. Post-operative infection was higher in OC as opposed to a laparoscopic cholecystectomy (TLC) or LCC (3.5% versus 0.7% versus 0.2%, P < 0.0001). The need for a blood transfusion was significantly higher in the OC and LCC groups as compared with the TLC group (19.2% versus 14.4% versus 6.2%, P < 0.0001). Reoperation was more frequent after OC or LCC versus TLC (1.5% versus 2.5% versus 0.8%, P = 0.007). In-hospital mortality was higher after OC as compared with TLC and LCC (8.3% versus 1.3% versus 1.4%, P < 0.0001). Conclusion: Patients with cirrhosis have increased in-hospital morbidity and mortality after an open as opposed to a laparoscopic or conversion to an open cholecystectomy. LC should be the preferred initial approach in cirrhotic patients.
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.
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.
Laparoscopic cholecystectomy in liver cirrhosis patients: An Egyptian experience
Surgical Practice, 2012
Aim: Cirrhosis represents a common histological pathway for a wide variety of chronic liver diseases. Hepatitis C virus (HCV) is the most important cause of liver cirrhosis in Egypt. Although cirrhosis has been regarded as a relative contraindication for laparoscopic cholecystectomy (LC) as a result of bleeding complications and subsequent liver failure, several reports support the safety of LC in selected patients. This was a prospective study to evaluate the efficacy and safety of LC in cirrhotic patients. Methods: A total of 177 hepatitis C positive patients with chronic calculus cholecystitis who here scheduled for LC between January 2010 and March 2011 were included in the present study. LC was carried out on patients who fulfilled the inclusion criteria. Two risk stratification-schemes were used to estimate the perioperative risk of patients with cirrhosis; the Child-Turcotte-Pugh (CTP) score and the Model for End-stage Liver Disease (MELD) score. Results: All patients were HCV-positive patients with Child class A cirrhosis and MELD score Յ 9. Mean surgical time was 55 min. Surgical difficulty varied between average in 64%, moderate in 28% and extensive in 8%, where 3.4% required conversion to open cholecystectomy. Postoperative follow up of all patients was a multidisciplinary approach by both surgeons and hepatologists. All patients showed sound recovery confirmed by abdominal sonar to exclude intra-abdominal collections, and application of both CTP and MELD scores, where all patients kept a Child class A score and MELD score Յ 9. Conclusion: LC is a safe procedure for hepatitis C-positive cirrhotic patients when established risk stratifications systems, such as CTP and MELD scores, are used for evaluation.
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.
Clinical Gastroenterology and Hepatology, 2004
Background & Aims: Patients with cirrhosis have an increased risk for cholelithiasis but also have an increased risk for morbidity and mortality after cholecystectomy. Current preoperative assessment of surgical risk is imprecise. Our aims were to identify preoperative factors that would accurately predict the risk for cholecystectomy in patients with cirrhosis. Methods: Preoperative clinical or biochemical parameters were determined for 33 patients with cirrhosis and 31 age-and sex-matched patients without cirrhosis. The use of these parameters and of the Child-Pugh and model for endstage liver disease (MELD) scores as preoperative predictors of outcome after surgery were assessed. Results: There were 2 deaths, both in cirrhotic patients. The overall risk for morbidity or mortality was increased in cirrhotic patients compared with controls. Postoperative morbidity was significantly associated with preoperative increases of international normalized ratio >1.2, bilirubin >1.0 mg/dL, creatinine >1.4 mg/dL, and a decreased platelet count <150 ؋ 10 3 /mL. The MELD and Child-Pugh scores accurately predicted postoperative morbidity, with an area under the curve of 0.938 and 0.839, respectively. A preoperative MELD score of >8 had a sensitivity of 91% and a specificity of 77% for predicting postoperative morbidity. Persons with a MELD score of >8 had increased 30-and 90-day global charges and increased blood product usage. Conclusions: Preoperative biochemical parameters, international normalized ratio, bilirubin, platelets, and creatinine can predict increased morbidity in cirrhotic patients. A MELD score of >8 identifies a group at high risk for postoperative morbidity after cholecystectomy.
Laparoscopic versus open cholecystectomy in cirrhotic patients: A prospective randomized study
International Journal of Surgery, 2009
Background: Improved laproscopic experience and techniques have made laparoscopic cholecystectomy (LC) feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy (OC) versus LC in compensated cirrhosis. Method: A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group (55 patients) and LC group (55 patients). Results: There was no operative mortality. In LC group 4 (7.33%) patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group (96.13 þ 17.35 min versus 76.13 þ 15.12) P < 0.05, associated with significantly higher intraoperative bleeding in OC group (P < 0.01), necessitating blood transfusions to 7 (12.72%) patients in OC group. The time to resume diet was 18.36 þ 8.18 h in LC group which is significantly earlier than in OC group 47.84 þ 14.6 h P < 0.005. Hospital stay was significantly longer in OC group than LC group (6 þ 1.74 days versus 1.87 þ 1.11 days) P < 0.01 with low postoperative morbidity. Conclusion: LC in cirrhotics is still complicated and highly difficult which associates with significant morbidity compared with that of patients without cirrhosis. However, it offers lower morbidity, shorter operative time; early resume dieting with less need for blood transfusion and reducing hospital stay than OC.