Laparoscopic cholecystectomy in patients with liver cirrhosis

Abstract

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.