Surgical Endoscopy

, Volume 24, Issue 2, pp 407–412 | Cite as

Laparoscopic cholecystectomy in cirrhotic patients: the value of MELD score and Child–Pugh classification in predicting outcome

  • Spiros Delis
  • Andreas Bakoyiannis
  • Juan Madariaga
  • John Bramis
  • Nikos Tassopoulos
  • Christos Dervenis



Laparoscopic cholecystectomy is a challenging procedure in patients with cirrhosis. This study aims to evaluate the safety and outcome of laparoscopic cholecystectomy in patients with cirrhosis and examines the value of model for end-stage liver disease (MELD) score and Child–Pugh classification in predicting morbidity.

Materials and methods

From January 1995 to July 2008, 220 laparoscopic cholecystectomies were performed in cirrhotic, Child–Pugh class A and B patients. Indications included symptomatic gallbladder disease and cholecystitis. MELD score ranged between 8 and 27. Child–Pugh class and MELD score were preoperatively calculated and associated with postoperative results. Data regarding patients and surgical outcome were retrospectively analyzed.


No deaths occurred. Postoperative morbidity occurred in 19% of the patients and included hemorrhage, wound complications, and intra-abdominal collections controlled conservatively. Intraoperative difficulty due to liver bed bleeding was experienced in 19 patients. Conversion to open cholecystectomy was necessary in 12 cases. Median operative time was 95 min. Median hospital stay was 4 days. Patients with preoperative MELD score above 13 showed a tendency for higher complication rate postoperatively. Child–Pugh classification did not seem to predict morbidity effectively.


Laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis Child–Pugh A and B and symptomatic cholelithiasis with acceptable morbidity. Some of its advantages are shorter operative time and reduced hospital stay. MELD score seems to predict morbidity more accurately than Child–Pugh classification system.


Cirrhosis Laparoscopic cholecystectomy MELD 


  1. 1.
    Bouchier IA (1969) Postmortem study of the frequency of gallstones in patients with cirrhosis of the liver. Gut 10(9):705–710CrossRefPubMedGoogle Scholar
  2. 2.
    Morino M, Cavuoti G, Miglietta C, Giraudo G, Simone P (2000) Laparoscopic cholecystectomy in cirrhosis: contraindication or privileged indication? Surg Laparosc Endosc Percutan Tech 10(6):360–363PubMedGoogle Scholar
  3. 3.
    Poggio JL, Rowland CM, Gores GJ, Nagorney DM, Donohue JH (2000) A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease. Surgery 127(4):405–411CrossRefPubMedGoogle Scholar
  4. 4.
    Anonymous (1992) Gallstones and laparoscopic cholecystectomy. NIH Consens Statement 14–16;10(3):1–28Google Scholar
  5. 5.
    Angrisani L, Lorenzo M, Corcione F, Vincenti R (1997) Gallstones in cirrhotics revisited by a laparoscopic view. J Laparoendosc Adv Surg Tech A 7(4):213–220CrossRefPubMedGoogle Scholar
  6. 6.
    Aranha GV, Sontag SJ, Greenlee HB (1982) Cholecystectomy in cirrhotic patients: a formidable operation. Am J Surg 143(1):55–60CrossRefPubMedGoogle Scholar
  7. 7.
    Cobb WS, Heniford BT, Burns JM, Carbonell AM, Matthews BD, Kercher KW (2005) Cirrhosis is not a contraindication to laparoscopic surgery. Surg Endosc 19(3):418–423CrossRefPubMedGoogle Scholar
  8. 8.
    Puggioni A, Wong LL (2003) A metaanalysis of laparoscopic cholecystectomy in patients with cirrhosis. J Am Coll Surg 197(6):921–926CrossRefPubMedGoogle Scholar
  9. 9.
    Currò G, Iapichino G, Melita G, Lorenzini C, Cucinotta E (2005) Laparoscopic cholecystectomy in Child–Pugh class C cirrhotic patients. JSLS 9(3):311–315PubMedGoogle Scholar
  10. 10.
    Schiff J, Misra M, Rendon G, Rothschild J, Schwaitzberg S (2005) Laparoscopic cholecystectomy in cirrhotic patients. Surg Endosc 19(9):1278–1281CrossRefPubMedGoogle Scholar
  11. 11.
    El-Awadi S, El-Nakeeb A, Youssef T, Fikry A, Abd El-Hamed TM, Ghazy H et al (2009) Laparoscopic versus open cholecystectomy in cirrhotic patients: a prospective randomized study. Int J Surg 7(1):66–69CrossRefPubMedGoogle Scholar
  12. 12.
    Fernandes NF, Schwesinger WH, Hilsenbeck SG, Gross GW, Bay MK, Sirinek KR et al (2000) Laparoscopic cholecystectomy and cirrhosis: a case-control study of outcomes. Liver Transpl 6(3):340–344CrossRefPubMedGoogle Scholar
  13. 13.
    del Olmo JA, Flor-Lorente B, Flor-Civera B, Rodriguez F, Serra MA, Escudero A et al (2003) Risk factors for nonhepatic surgery in patients with cirrhosis. World J Surg 27(6):647–652CrossRefPubMedGoogle Scholar
  14. 14.
    Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC (2000) A model to predict poor survival in patients undergoing transjujalar intrahepatic portosystemic shunts. Hepatology 31:864–871CrossRefPubMedGoogle Scholar
  15. 15.
    Freeman RB Jr, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E et al (2002) The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl 8:851–858CrossRefPubMedGoogle Scholar
  16. 16.
    Northup PG, Wanamaker RC, Lee VD, Adams RB, Berg CL (2005) Model for end-stage liver disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis. Ann Surg 242:244–251CrossRefPubMedGoogle Scholar
  17. 17.
    Befeler AS, Palmer DE, Hoffman M, Longo W, Solomon H, Di Bisceglie AM (2005) The safety of intra-abdominal surgery in patients with cirrhosis: model for end-stage liver disease is superior to Child–Turcotte–Pugh classification in predicting outcome. Arch Surg 140:650–654CrossRefPubMedGoogle Scholar
  18. 18.
    Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60(8):646–649CrossRefPubMedGoogle Scholar
  19. 19.
    MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR (1998) Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc 12(4):315–321CrossRefPubMedGoogle Scholar
  20. 20.
    Misra M, Schiff J, Rendon G, Rothschild J, Schwaitzberg S (2005) Laparoscopic cholecystectomy after the learning curve: what should we expect? Surg Endosc 19(9):1266–1271CrossRefPubMedGoogle Scholar
  21. 21.
    Cryer HM, Howard DA, Garrison RN (1985) Liver cirrhosis and biliary surgery: assessment of risk. South Med J 78(2):138–141PubMedGoogle Scholar
  22. 22.
    Sirinek KR, Burk RR, Brown M, Levine BA (1987) Improving survival in patients with cirrhosis undergoing major abdominal operations. Arch Surg 122(3):271–273PubMedGoogle Scholar
  23. 23.
    Teh SH, Nagorney DM, Stevens SR, Offord KP, Therneau TM, Plevak DJ et al (2007) Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology 132(4):1261–1269CrossRefPubMedGoogle Scholar
  24. 24.
    Tuech JJ, Pessaux P, Regenet N, Rouge C, Bergamaschi R, Arnaud JP (2002) Laparoscopic cholecystectomy in cirrhotic patients. Surg Laparosc Endosc Percutan Tech 12(4):227–231CrossRefPubMedGoogle Scholar
  25. 25.
    Yerdel MA, Tsuge H, Mimura H, Sakagami K, Mori M, Orita K (1993) Laparoscopic cholecystectomy in cirrhotic patients: expanding indications. Surg Laparosc Endosc 3(3):180–183PubMedGoogle Scholar
  26. 26.
    Freeman RB Jr (2003) MELD/PELD: one year later. Transplant Proc 35(7):2425–2427CrossRefPubMedGoogle Scholar
  27. 27.
    Salerno F, Merli M, Cazzaniga M, Valeriano V, Rossi P, Lovaria A et al (2002) MELD score is better than Child–Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol 36(4):494–500CrossRefPubMedGoogle Scholar
  28. 28.
    Ferral H, Gamboa P, Postoak DW, Albernaz VS, Young CR, Speeg KV et al (2004) Survival after elective transjugular intrahepatic portosystemic shunt creation: prediction with model for end-stage liver disease score. Radiology 231(1):231–236CrossRefPubMedGoogle Scholar
  29. 29.
    Farnsworth N, Fagan SP, Berger DH, Awad SS (2004) Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients. Am J Surg 188(5):580–583CrossRefPubMedGoogle Scholar
  30. 30.
    Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD (2004) Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child–Pugh and MELD scores. Clin Gastroenterol Hepatol 2(8):719–723CrossRefPubMedGoogle Scholar
  31. 31.
    Yerdel MA, Koksoy C, Aras N, Orita K (1997) Laparoscopic versus open cholecystectomy in cirrhotic patients: a prospective study. Surg Laparosc Endosc 7(6):483–486CrossRefPubMedGoogle Scholar
  32. 32.
    Leandros E, Albanopoulos K, Tsigris C, Archontovasilis F, Panoussopoulos SG, Skalistira M et al (2008) Laparoscopic cholecystectomy in cirrhotic patients with symptomatic gallstone disease. ANZ J Surg 78(5):363–365CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Spiros Delis
    • 1
    • 2
  • Andreas Bakoyiannis
    • 2
  • Juan Madariaga
    • 1
  • John Bramis
    • 3
  • Nikos Tassopoulos
    • 4
  • Christos Dervenis
    • 2
  1. 1.Division of Liver and GI TransplantationUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Liver Surgical Unit, 1st Surgical DepartmentKostantopouleio-“Agia Olga” HospitalAthensGreece
  3. 3.Ippokration General Hospital, Medical SchoolUniversity of AthensAthensGreece
  4. 4.First Department of MedicineWestern Attica General HospitalAthensGreece

Personalised recommendations