Clinical observation of laparoscopic treatment of gallstone patients with cirrhosis

Abstract

Objective To investigate the feasibility and benefits of laparoscopic cholecystectomy(LC)in cirrhotic patients with cholecystolithiasis. Methods The clinical data of 105 cases of cholecystolithiasis associated with liver cirrhosis were retrospectively analyzed. All patients were divided into laparoscopic cholecystectomy group (n=54) and open cholecystectomy group (n=51). The two groups were compared regarding operative time, blood loss, surgical complications, postoperative liver function, postoperative hospital stay and hospital costs. The incidence rate of the complications and the risk factors for the complications were also analyzed. Results As compared with open cholecystectomy group, the operative time [52.5(35-150) min vs 70(45-150) min] and postoperative hospital stay[ (3.9±2.9) days vs (9.5±4.8) days] were shorter, blood loss was less [50(20-280)ml vs 75(30-500)ml], and the changes of liver function and Child-Pugh score were milder in laparoscopic cholecystectomy group. The differences were statistically significant (P 0.05). According to the univariate analysis, the Child-Pugh class and preoperative ascites were risks factors for the postoperative complications (P<0.05). Further analysis using multiple logistic regression illustrated that preoperative ascites was independent risk factor for the postoperative complications (OR=10.258, 95%CI 1.364-77.146, P=0.024). Conclusions Laparoscopic cholecystectomy is an effective and safe treatment for symptomatic gallstone disease in patients with Child-Pugh A and B cirrhosis. The advantages over open cholecystectomy are the shorter operative time and postoperative hospital stay, the less blood less and the milder effect on liver function. The occurrence of the complications for the cirrhotic patients with cholecystolithiasis undergoing cholecystectomy is closely associated with the preoperative ascites. Key words: Cholecystolithiasis; Liver cirrhosis; Laparoscopic cholecystectomy