Laparoscopic cholecystectomy in cirrhotics

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background and Objectives: Due to the concern of risk of intra- and postoperative complications and associated morbidity, cirrhosis of the liver is often considered a contraindication for laparoscopic cholecystectomy (LC). This article intends to review the literature and underline the various approaches to dealing with this technically challenging procedure. Methods: A Medline search of major articles in the English literature on LC in cirrhotic patients over a 16-y period from 1994 to 2011 was reviewed and the findings analyzed. A total of 1310 cases were identified. Results: Most the patients who underwent LC were in Child-Pugh class A, followed by Child-Pugh classes B and C, respectively. The overall conversion rate was 4.58%, and morbidity was 17% and mortality 0.45%. Among the patients who died, most were in Child-Pugh class C, with a small number in classes B and A. The cause of death included, postoperative bleeding, liver failure, sepsis, duodenal perforation, and myocardial infarction. A metaanalysis of 400 patients in the literature, comparing outcomes of patients undergoing LC with and without cirrhosis, revealed higher conversion rate, longer operative time, higher bleeding complications, and overall increased morbidity in patients with cirrhosis. Safe LC was facilitated by measures that included the use of ultrasonic shears and other hemostatic measures and using subtotal cholecystectomy in patients with difficult hilum and gallbladder bed. Conclusions: Laparoscopic cholecystectomy can be safely performed in cirrhotic patients, within Child-Pugh classes A and B, with acceptable morbidity and conversion rate.

Original languageEnglish
Pages (from-to)392-400
Number of pages9
JournalJournal of the Society of Laparoendoscopic Surgeons
Volume16
Issue number3
DOIs
Publication statusPublished - Jul 2012

Fingerprint

Laparoscopic Cholecystectomy
Morbidity
Fibrosis
Hemorrhage
Literature
Intraoperative Complications
Liver Failure
Cholecystectomy
Hemostatics
Operative Time
Gallbladder
Ultrasonics
Liver Cirrhosis
Cause of Death
Sepsis
Myocardial Infarction
Mortality

Keywords

  • Cirrhosis
  • Laparoscopic cholecystectomy
  • Subtotal cholecystectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic cholecystectomy in cirrhotics. / Machado, Norman Oneil.

In: Journal of the Society of Laparoendoscopic Surgeons, Vol. 16, No. 3, 07.2012, p. 392-400.

Research output: Contribution to journalArticle

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