Clinical efficacy of laparoscopic cholecystectomy for cholecystolithiasis complicated with liver cirrhosis in elderly patients

Abstract

Objective To investigate the safety, feasibility and clinical efficacy of laparoscopic cholecystectomy (LC) for cholecystolithiasis complicated with liver cirrhosis in the elderly patients. Methods Clinical data of 45 elderly patients with cholecystolithiasis complicated with liver cirrhosis who were admitted to the Affiliated Hospital of North Sichuan Medical College between July 2009 and July 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among the patients, 27 cases were males and 18 were females, aged 60-73 years old with a median age of 65 years old. Thirty-eight cases were evaluated as Child-Pugh classification A and 7 as B. Five cases were complicated with hypertension, 3 with diabetes mellitus and 1 with pulmonary emphysema. Results During the perioperative period, corresponding measures were implemented to protect the liver function, improve the coagulation function and closely monitor the blood pressure and blood glucose. One case underwent emergent LC due to the incarcerated stones in the gallbladder neck, and the remaining cases underwent selective LC. Three cases converted to open surgery with the rate of 7%(3/45). The reasons for conversion to open surgery were hemorrhage and unclear dissection of Calot's triangle. Abdominal hemorrhage was observed in 1 case 2 d after surgery, and alleviated after treatment of thrombin and vitamin K1 for 4 d. Pulmonary infection was observed in 2 cases, urinary tract infection in 1 case, adhesive ileus in 1 case and lacunar cerebral infarction in 1 case, and were all cured by conservative treatment. No severe surgical complications, such as bile leakage, biliary tract trauma, hemorrhage or accessory injury of peripheral organs were observed. Conclusions For elderly patients with cholecystolithiasis complicated with liver cirrhosis, during the perioperative period, effective measures should be strengthened to protect the liver function, improve the preoperative examinations, enhance the surgical precision, and control the intraoperative hemorrhage. Open surgery should be converted timely to avoid the emergent LC. Key words: Aged; Liver cirrhosis; Cholecystolithiasis; Cholecystectomy, laparoscopic