Laparoscopic versus Open Cholecystectomy in Cirrhotic Patients: A Prospective Comparative Study

Abstract

Background: Prevalence of gallstones in cirrhotics is estimated at 29-46% and thus is three times as high as those without liver cirrhosis. Cirrhosis increase incidence of gallstones formation (black stones) with an overall prevalence of 25% to 30%.Aim Study: To compare between the rationale, risk and morbidity of open cholecystetomy versus and laparoscopic cholecystectomy in cirrhotic patients. As regard to operative time, intra operative and post-operative blood loss, time to resume diet, complications, mortality incidence, and postoperative subjective pain score.Patients and Method: This study was a prospective comparative study on laparoscopic versus open cholecystectomy in cirrhotic patients. The cases were performed in the period from April 2016 till October 2018. 100 patients with symptomatic gallstone disease and liver cirrhosis including Child class A or Child class B, were randomly divided into two groups, Group (A): Laparoscopic Cholecystectomy (LC) and Group (B): Open Cholecystectomy (OC).Results: In LC group two cases (4%) were converted to open cholecystectomy. Mean surgical times were significantly shorter in LC (Group A) group. The mean +SD (in minutes) of OC (Group B) and LC (Group A) was 97.69 ± 15.79 versus 63.58 ± 9.93, respectively, (p<0.001), associated with significantly higher intraoperative bleeding in OC group (p<0.001). The mean time to resume diet (hours) was 10.69 ± 5.41 in (Group A) it was significantly earlier than in (Group B) 24.15 ±6.74 (p<0.001). The length of hospital stay (days) was significantly longer in (Group B) with a mean hospital stay 5.08 ± 1.56, compared with a mean hospital stay 2.60 ±0.61 for (Group A) (p<0.001) with low post-operative morbidity and no operative mortality. Conclusion:Laparoscopic Cholecystectomy (LC) offers safe and effective surgical treatment for cirrhotic patients of (Child class A and early B) suffering from gallstone disease, as it has lower morbidity, shorter operative time; early resumption diet with less need for blood transfusion and reducing hospital stay than OC.