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Laparoscopic Cholecystectomy in Cirrhotic Patients with Symptomatic Cholelithiasis: A Case-control Study

Abstract

Background

In this study we retrospectively evaluated a group of symptomatic cirrhotic (n = 30) and non-cirrhotic (n = 60) patients submitted to laparoscopic cholecystectomy (LC) in a public hospital in Brazil.

Methods

The groups were compared for surgical time, duration of hospitalization after surgery, period of permanence in the intensive care unit (ICU), use of blood derivatives, mortality rates, and transoperative and post-surgery complications. Other parameters, such as hepatic reserve capacity and presence of ascites, were also analyzed.

Results

Twenty-three (76.7%) of the patients of the cirrhosis group (CG) were classified as Child-Pugh A, and seven (23.3%) were Child-Pugh B. Six of them (20%) had ascites. Differences between the two groups included surgery time (p = 0.008), duration of hospitalization (p = 0.014), and post-surgery (p = 0.000) or ambulatory (p = 0.008) complications. The worst results were observed among Child B patients and in those with ascites. Blood derivatives were used in only 3.3% of the CG patients. No cases of conversion to laparotomy were observed among the two groups of patients included in this study, nor were there any deaths.

Conclusions

These results indicate that videolaparoscopic cholecystectomy may be safely performed in public hospitals in Brazil, with low levels of complications, no associated mortality, and no need for blood derivatives.

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References

  1. 1.

    National Institutes of Health Consensus Development Conference Statement on Gallstones and Laparoscopic Cholecystectomy (1993) Am J Surg 165:390–398

    Article  Google Scholar 

  2. 2.

    Yerdel MA, Tsuge H, Mimura H, et al. (1993) Laparoscopic cholecystectomy in cirrhotic patients: expanding indications. Surg Laparosc Endosc 3:180–183

    PubMed  CAS  Google Scholar 

  3. 3.

    Soper NJ (1993) Effect of nonbiliary problems on laparoscopic cholecystectomy. Am J Surg 165:522–526

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Lacy AM, Balaguer C, Andrade E, et al. (1995) Laparoscopic cholecystectomy in cirrhotic patients. Indication or contradiction? Surg Endosc 9:407–408

    PubMed  CAS  Google Scholar 

  5. 5.

    Sleeman D, Namias N, Levi D, et al. (1998) Laparoscopic cholecystectomy in cirrhotic patients. J Am Coll Surg 187:400–403

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    D’Albuquerque LAC, de Miranda MP, Genzini T, et al. (1995) Laparoscopic cholecystectomy in cirrhotic patients. Surg Laparosc Endosc 5:272–276

    PubMed  CAS  Google Scholar 

  7. 7.

    Da Silveira EB (2006) Outcome of cirrhotic patients undergoing cholecystectomy: applying Bayesian analysis in gastroenterology. J Gastroenterol Hepatol 21:958–962

    PubMed  Article  Google Scholar 

  8. 8.

    Pezzolla F, Lorusso D (1997) Morbidity after vídeo-laparoscopic cholecystectomy in cholelithiasis associated with liver cirrhosis. A case-control study. Ann Ital Chir 68:837–840

    CAS  Google Scholar 

  9. 9.

    Fernandes NF, Schwesinger WH, Hilsenbeck SG, et al. (2000) Laparoscopic cholecystectomy and cirrhosis: a case-control study of outcomes. Liver Transplant 6:340–344

    Article  CAS  Google Scholar 

  10. 10.

    Tuech JJ, Pessaux P, Regenet N, et al. (2002) Laparoscopic cholecystectomy in cirrhotic patients. Surg Laparosc Endosc Percutan Tech 12:227–231

    PubMed  Article  Google Scholar 

  11. 11.

    Hasson HM (1988) Modified instrument and method for laparoscopy. Am J Obst Gynecol 151:67–81

    Google Scholar 

  12. 12.

    Schwartz SI (1981) Bilary tract surgery and cirrhosis: a critical combination. Surgery 90:577–583

    PubMed  CAS  Google Scholar 

  13. 13.

    Aranha GV, Sontag SJ, Greenlee HB (1982) Cholecystectomy in cirrhotic patients: a formidable operation. Am J Surg 143:55–60

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Curro G, Iapichino G, Melita G, et al. (2005) Laparoscopic cholecystectomy in Child-Pugh class C cirrhotic patients. JSLS 9:311–315

    PubMed  Google Scholar 

  15. 15.

    Puggioni A, Wong LL (2003) A metaanalysis of laparoscopic cholecystectomy in patients with cirrhosis. J Am Coll Surg 197:921–926

    PubMed  Article  Google Scholar 

  16. 16.

    Chao SH, Lee PH (1994) Transmural suture technique for trocar-site bleeding following laparoscopic cholecystectomy. Surg Endosc 8:1230–1231

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Hamid S, Siddiqui M, Jafri W, et al. (1993) Outcome of biliary tract surgery in unknown cirrhosis: a case-control study. Ann R Coll Surg Engl 75:434–436

    PubMed  CAS  Google Scholar 

  18. 18.

    Wu CC, Hwang CJ, Fang JH, et al. (1995) Definitive surgical treatment for cholelithiasis in selected patients with liver cirrhosis. HPB Surg 9:43–46

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Gugenheim J, Casaccia M Jr, Mazza D, et al. (1996) Laparoscopic surgery in cirrhotic patients. HPB Surg 10:79–82

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Adriano Miziara Gonzalez.

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Mancero, J.M.P., D’Albuquerque, L.A.C., Gonzalez, A.M. et al. Laparoscopic Cholecystectomy in Cirrhotic Patients with Symptomatic Cholelithiasis: A Case-control Study. World J Surg 32, 267–270 (2008). https://doi.org/10.1007/s00268-007-9314-x

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Keywords

  • Laparoscopic Cholecystectomy
  • Cirrhotic Patient
  • Choledocholithiasis
  • Subcutaneous Emphysema
  • Conventional Laparoscopic Cholecystectomy