Laparoscopic cholecystectomy in cirrhotic patients

Abstract

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.

Laparoscopic Cholecystectomy in Cirrhotic Patients with Symptomatic Cholelithiasis

“…Therefore, several clinical trials considered cirrhosis a certain contraindication for laparoscopic cholecystectomy. Despite these views, with increased experience in laparoscopy and availability of more ergonomic tools and intraoperative homeostatic products some studies advocate that laparoscopic cholecystectomy in patients with cirrhosis should be widely used (11)(12)(13). In addition, because of the complications of open cholecystectomy (fibrosis, hernias, wound infections, etc.)…”

Laparoscopic treatment of cholelithiasis in cirrhotic patients

“…Blood loss during the surgical procedure is one of the most serious perioperative complications when dealing with cirrhotic patients, and it usually occurs in 57% of patients undergoing laparotomy (8).…”

“…This percentage is reduced in the case of laparoscopy thanks to the meticulous handling of this technique, magnification of the operative field, and the specific effects of barohemostasis as determined by pneumoperitoneum (4,(8)(9)(10)(11).…”

Colecistectomia laparoscópica em cirróticos

“…Naqueles pacientes compensados com indicação de colecistectomia, os resultados de várias séries (8,10,15,21,25) sugerem que a via laparoscópica é método de abordagem seguro, pois permite todas as vantagens funcionais e estéticas já conhecidas, com índices de complicações semelhantes ao dos indivíduos não-cirróticos.…”

“…BLOCH et al (3) realizaram colecistectomia em 49 pacientes cirróticos, com mortalidade de 23,5% em 17 pacientes Child C e de 0% em 21 Child A, com mortalidade total de 10,2%. As principais complicações foram hemorragia pós-operatória do leito vesicular com a resultante falência hepática, e sepse.…”