Laparoscopic versus Open Cholecystectomy in Cirrhotic Patients: A Prospective Comparative Study

Abstract

Abstract Background: Prevalence of gallstones in cirrhotics is estimated at 29-46% and thus is three times as high as those without liver cirrhosis. Cirrhosis increase incidence of gall-stones formation (black stones) with an overall prevalence of 25% to 30%. Aim Study: To compare between the rationale, risk and morbidity of open cholecystetomy versus and laparoscopic cholecystectomy in cirrhotic patients. As regard to operative time, intra operative and post-operative blood loss, time to resume diet, complications, mortality incidence, and post-operative subjective pain score. Patients and Method: This study was a prospective com-parative study on laparoscopic versus open cholecystectomy in cirrhotic patients. The cases were performed in the period from April 2016 till October 2018. 100 patients with sympto-matic gallstone disease and liver cirrhosis including Child class A or Child class B, were randomly divided into two groups, Group (A): Laparoscopic Cholecystectomy (LC) and Group (B): Open Cholecystectomy (OC). Results: In LC group two cases (4%) were converted to open cholecystectomy. Mean surgical times were significantly shorter in LC (Group A) group. The mean +SD (in minutes) of OC (Group B) and LC (Group A) was 97.69±15.79 versus 63.58±9.93, respectively, (p<0.001), associated with significantly higher intraoperative bleeding in OC group (p<0.001). The mean time to resume diet (hours) was 10.69± 5.41 in (Group A) it was significantly earlier than in (Group B) 24.15±6.74 (p<0.001). The length of hospital stay (days) was significantly longer in (Group B) with a mean hospital stay 5.08±1.56, compared with a mean hospital stay 2.60±0.61 for (Group A) (p<0.001) with low post-operative morbidity and no operative mortality. Conclusion: Laparoscopic Cholecystectomy (LC) offers safe and effective surgical treatment for cirrhotic patients of (Child class A and early B) suffering from gallstone disease, as it has lower morbidity, shorter operative time; early re-sumption diet with less need for blood transfusion and reducing hospital stay than OC.