Abstract
Compensated cirrhosis means that the liver is heavily scarred but can still perform many important functions; many peoples with compensated cirrhosis have gall bladder stones. The advantages of laparoscopic cholecystectomy (LC) for most patients have been extensively published. However its benefits and successful use in patients with cirrhosis are less documented.The study compromised 50 patients with symptomatic gallstone in compensated liver disease and undergone either open cholecystectomy (OC) or laparoscopic cholecystectomy. These patients were randomized into two groups: Group I included 24 patients who underwent OC, and group II included 26 patients who underwent LC. Patient’s age, sex, clinical presentation and Child-Turcotte-Pugh (CTP) class were documented. No patients in this study had CTP class c cirrhosis.IL-6 was measured by ELISA, postoperative pain (measured by Visual analog scale), hospital stay, blood loss, recovery time (return to work), and liver function tests were documented.IL-6 was significantly lowered at 6th hour and 12th hour post operative in LC group. Mean surgical time was significantly longer in OC than LC group, (mean±SD, 96.6±32 vs 58.7±23.8min, P=0.037). No patients in group II required any blood replacement in contrast to 9 patients (37.5%) in group I. Intraoperative bleeding remained significantly higher in group I (P=0.043). No patients in group II had wound complications compared with 5 patients (29.14%) in group I. Group I had significantly longer hospital stay than group II, mean 9.0+1.3days (median 7) vs 2.3days+1.9 (median 2.5); P=0.001.Our results were demonstrated that laparoscopic cholecystectomy can be performed safely in patients with CTP class A and B cirrhosis. IL-6 was more significantly, increased post operatively in open cholecystectomy than laparoscopic one and it correlated well with intensity of operative trauma.
Highlights
Hepatitis C virus (HCV) infection affects an estimated 170 million individuals worldwide, and 5 million in the United States, where it is currently recognized as the most prevalent bloodborne infection and the leading indication for a liver transplant [1].Treatment of HCV with pegylated interferon-a-2a is successful in eradicating virus from only 30% to 80% of those treated, with individuals infected with the more resilient genotype-1 virus having markedly lower response rates than those with non-genotype-1 infections
This study included 50 patients with hepatic cirrhosis and symptomatic gall stones disease who underwent cholecystectomy at Mansoura University Hospital, Mansoura, Egypt. These patients were subjected to a thorough history and clinical examination focused on manifestation of gall stone disease and chronic liver disease
Three cases were converted from laparoscopic into open cholecystectomy
Summary
Treatment of HCV with pegylated interferon-a-2a is successful in eradicating virus from only 30% to 80% of those treated, with individuals infected with the more resilient genotype-1 virus having markedly lower response rates than those with non-genotype-1 infections. Differences in outcome have been described by race, with African Americans having significantly lower response rates than Caucasian Americans [2,3,4]. Expressed in a number of different cell types, including, hepatocytes, macrophages, B-cells and T-cells, interleukin-6 (IL-6) is a pleiotropic cytokine important in the immunologic response to infections. IL-6 plays an important role in HCV infection as well as the response to IFN therapy. A recent study has suggested the potential importance of IL-6 in the treatment response of HCV patients to interferon-based therapy [5]
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