Laparoscopic cholecystectomy in cirrhotic patients with symptomatic cholelithiasis

Abstract

Background Gallstones are twice as common in cirrhotic patients as in the general population. Although laparoscopic cholecystectomy (LC) has become the gold standard for symptomatic gallstones, cirrhosis has been considered an absolute or relative contraindication. Many authors have reported on the safety of LC in cirrhotic patients. We reviewed our patients retrospectively and assessed the safety of LC in cirrhotic patients at our unit of Zagazig University Hospital. Patients and methods From January 2014 to December 2016, a total of 200 patients underwent LC for symptomatic gallstone disease. All the cirrhotic patients with Child–Pugh class A and B cirrhosis undergoing LC were included in the study. Cirrhosis was diagnosed based on clinical, biochemical, ultrasonography, and intraoperative findings of the nodular liver and histopathological study. Results Of the 200 patients undergoing LC, 20 (10%) were cirrhotic. Of these 20, 12 (60%) were Child’s group A and eight (40%) were group B; 65% had hepatitis C, 5% had hepatitis B, 20% had combined C and B hepatitis, and 10% were had hepatitis. Preoperative diagnosis of cirrhosis was possible in 90% of cases, and 10% were diagnosed during surgery. The morbidity rate was 20% and no mortality was seen. One patient had hemorrhage, one patient developed postoperative ascites, one patient showed wound infection, and another one had trocar site hematoma. The mean hospital stay was 2.9±0.1 days. Of the 20 cases, two (10%) were converted to open cholecystectomy. The mean operation time was 75.2±32.54 min. Conclusion LC is an effective and safe treatment for symptomatic gallstone disease in select patients with Child–Pugh A and B cirrhosis. The advantages over open cholecystectomy are the lower morbidity rate and reduced hospital stay.