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The study investigated the hemodynamic and neurohumoral effects of albumin infusion after total paracentesis in 18 patients with cirrhosis and tense ascites. Measurements of systemic and splanchnic hemodynamics, and vasoactive neurohumoral systems were performed before and immediately after total paracentesis. The patients were then randomized to receive albumin or not, and hemodynamic and humoral measurements were repeated at 24 hours. Hemodynamic and humoral changes just after paracentesis were similar in patients later randomized to receive albumin infusion or not. Twenty-four hours after total paracentesis, patients not receiving albumin had significant reductions in cardiac index (-13%; P = .005), femoral blood flow (-17% P = .004), and pulmonary capillary pressure (-16%; P = .02), which were accompanied by significant increases in plasma renin activity (PRA) and plasma aldosterone (PA) and by significant decreases in atrial natriuretic factor (ANJ?) and plasma sodium. By contrast, there were no significant changes in patients receiving albumin, except for an increase in ANF and a further decrease in PA. In both groups, hepatic venous pressure gradient (HVPG) and azygos blood flow decreased just after paracentesis returning to baseline at 24 hours. This study shows that albumin infusion prevents the impairment in systemic hemodynamics, vasoactive neurohumoral systems, and plasma sodium after a large-volume paracentesis, without detrimental effects on portal pressure and portocollateral blood flow. (HEPATOLOGY 1995;22: 753-758.)

Liver cirrhosis is considered a contraindication to laparoscopic cholecystectomy for the moment. Here we are reporting on results in the surgical treatment of gallstone disease in cirrhotic patients by laparoscopic means. We reviewed the experience over the final period of time in 11 patients since the introduction of laparoscopic procedures in our unit. The index of conversion rate was 9.1% (1/11). The morbidity was nil. The average length of hospital stay was 1.8 days (1-6 days). We propose the use of laparoscopic cholecystectomy in gallstone disease in patients with liver cirrhosis as first-line surgical treatment.

These findings suggest that helium intraperitoneal insufflation results in a greater impairment on hepatic blood flow than CO2 insufflation.