Laparoscopic cholecystectomy in liver cirrhosis patients: An Egyptian experience

Abstract

Aim: Cirrhosis represents a common histological pathway for a wide variety of chronic liver diseases. Hepatitis C virus (HCV) is the most important cause of liver cirrhosis in Egypt. Although cirrhosis has been regarded as a relative contraindication for laparoscopic cholecystectomy (LC) as a result of bleeding complications and subsequent liver failure, several reports support the safety of LC in selected patients. This was a prospective study to evaluate the efficacy and safety of LC in cirrhotic patients. Methods: A total of 177 hepatitis C positive patients with chronic calculus cholecystitis who here scheduled for LC between January 2010 and March 2011 were included in the present study. LC was carried out on patients who fulfilled the inclusion criteria. Two risk stratification-schemes were used to estimate the perioperative risk of patients with cirrhosis; the Child–Turcotte–Pugh (CTP) score and the Model for End-stage Liver Disease (MELD) score. Results: All patients were HCV-positive patients with Child class A cirrhosis and MELD score ≤ 9. Mean surgical time was 55 min. Surgical difficulty varied between average in 64%, moderate in 28% and extensive in 8%, where 3.4% required conversion to open cholecystectomy. Postoperative follow up of all patients was a multidisciplinary approach by both surgeons and hepatologists. All patients showed sound recovery confirmed by abdominal sonar to exclude intra-abdominal collections, and application of both CTP and MELD scores, where all patients kept a Child class A score and MELD score ≤ 9. Conclusion: LC is a safe procedure for hepatitis C-positive cirrhotic patients when established risk stratifications systems, such as CTP and MELD scores, are used for evaluation.