Laparoscopic cholecystectomy in patients with liver cirrhosis
Zafer Teke, Metin Ercan, Murat Ulaş, Tahsin Dalgıç, Erdal Birol Bostancı, Musa Akoğlu
Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Gastroenteroloji Cerrahi Kliniği, Ankara
Purpose: In this study, we aimed to evaluate surgical outcomes of cirrhotic patients who underwent laparoscopic cholecystectomy for gallstones in our clinic.
Patients and Methods: From 2003-2009, 18 cirrhotic patients underwent laparoscopic cholecystectomy for gallstones in our clinic. Investigated variables included age, gender, etiology of cirrhosis, Child-Pugh score, MELD score, ASA score, associated medical conditions, biliary pathology, preoperative laboratory parameters, operating time, conversion, use of drain, postoperative complications, reoperation and length of hospital stay.
Results: Thirteen patients (72.2%) were female and 5 (27.8%) were male. The median age was 61 years (range 34 - 80 years). Cirrhosis etiology was viral hepatitis in 5 patients, alcohol in 1, cryptogenic in 1, cardiogenic in 1, and in the ten remaining patients, liver cirrhosis could be identified only after intraoperative findings. Seventeen patients were classified as Child-Pugh A and one patient as Child- Pugh B. The median MELD score was 8 (range 6-16) and the median ASA score was 2 (range 1-3). The average operative time was 44 minutes (range 15-100 minutes). One patient required conversion to open surgery (5.6%). Drains were used in 11 patients (61.1%). Postoperative bleeding complications occured in two patients (11.1%). One patient was reoperated on for bleeding (5.6%). The median hospital stay was 2 days (range 1-7 days). The median follow-up period was 52 months (range 6-87 months).
Conclusion: This study demonstrates that laparoscopic cholecystectomy can be performed with acceptable morbidity in compensated cirrhotic patients. However, these operations should be carried out in an experienced center for hepato-biliary surgery to obtain the best surgical outcomes.
Keywords: Laparoscopic cholecystectomy, Liver cirrhosis, Gallstones