OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY FOR GALL STONES DISEASE IN PATIENTS WITH LIVER CIRRHOSIS

Authors

  • Nasir Khan
  • Ghulam Siddiq

Abstract

Background: Laparoscopic cholecystectomy (LC), a gold standard procedure for cholelithiasis, is associated with higher incidence of bile duct injuries and perioperative bleeding. These complications are of further concern when LC is carried out on patients with liver cirrhosis. Although LC is now increasingly being performed for cholelithiasis in cirrhotic patients, the safety of the procedure is debatable in this group of patients. Methods: We retrospectively analysed 82 LCs, performed between January 2002 and December 2011, in cirrhotic patients with gall stone disease for perioperative complications. Patients were sub-classified into Class A, B and C based on child-Pugh classification of severity of liver cirrhosis. Intergroup comparisons were carried out using ANOVA, and p≤0.05 was considered significant. Results: LC was successfully completed in all but 3 patients (3.7%). None of the cirrhotic patients had bile duct injury. Class C patients (n=27) had higher frequency of perioperative bleeding than Class B and A (p=0.03). Class C patients had comparatively longer stay (5.42 days; range 4–8 days) than Class B (3 days; range 2–6) and Class A (2.74 days; range 2–4), (p=0.01). There was no mortality in our series. Conclusion: The outcome in Child A and B cirrhosis is comparable to non-cirrhotic patients undergoing LC for gall stone disease. Conversion rate and perioperative bleeding in these groups of patients is acceptable in relevance to LC in non-cirrhotic patients. Child C patients however need careful assessment and determination of operative risk versus advantages.Keywords: Laparoscopic cholecystectomy, Cirrhosis, Cholelithiasis, Chronic liver disease

References

Vettoretto N, Saronni C, Harbi A, Balestra L, Taglietti L, Giovanetti M. Critical view of safety during laparoscopic cholecystectomy. JSLS 2011;15(3):322–5.

Tiwari MM, Reynoso JF, High R, Tsang AW, Oleynikov D. Safety, efficacy, and cost-effectiveness of common laparoscopic procedures. Surg Endosc 2011;25:1127–35.

Patel SC, Bhatt JR. Laparoscopic cholecystectomy at the Aga Khan Hospital, Nairobi. East Afr Med J 2000;77(4):194–8.

Ivatury SJ, Louden CL, Schwesinger WH. Contributing factors to postoperative length of stay in laparoscopic cholecystectomy. JSLS 2011;15:174–8.

Gurjar SV, Kulkarni D, Khawaja HT. Outpatient general surgical follow-up: are we using this resource effectively? Int J Surg 2009;7(1):62–5.

Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg 2001;234:549–58.

Strasberg SM. Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy. J Hepatobiliary Pancreat Surg 2008;15:284–92.

Katkhouda N, Mavor E, Mason RJ. Visual identification of the cystic duct-CBD junction during laparoscopic cholecystectomy (visual cholangiography): an additional step for prevention of CBD injuries. Surg Endosc 2000;14(1):88–9.

Tantia O, Sasmal PK, Patle N, Prasad P. Bile duct injury during laparoscopic cholecystectomy: mechanism and prevention. J Indian Med Assoc 2010;108:667–71.

Schiff J, Misra M, Rendon G, Rothschild J, Schwaitzberg S. Laparoscopic cholecystectomy in cirrhotic patients. Surg Endosc 2005;19:1278–81.

Nguyen KT, Kitisin K, Steel J, Jeyabalan G, Aggarwal S, Geller DA, et al. Cirrhosis is not a contraindication to laparoscopic cholecystectomy: results and practical recommendations. HPB (Oxford) 2011;13(3):192–7.

Fernandes NF, Schwesinger WH, Hilsenbeck SG, Gross GW, Bay MK, Sirinek KR, et al. Laparoscopic cholecystectomy and cirrhosis: a case-control study of outcomes. Liver Transpl 2000;6:340–4.

Lucidi V, Buggenhout A, Donckier V. Cholecystectomy in cirrhotic patients: pitfalls and reasonable recommendations. Acta Chir Belg 2009;109:477–80.

Pavlidis TE, Symeonidis NG, Psarras K, Skouras C, Kontoulis TM, Ballas K, et al. Laparoscopic cholecystectomy in patients with cirrhosis of the liver and symptomatic cholelithiasis. JSLS 2009;13:342–5.

Shaikh AR, Muneer A. Laparoscopic cholecystectomy in cirrhotic patients. JSLS 2009;13:592–6.

Currò G, Iapichino G, Melita G, Lorenzini C, Cucinotta E. Laparoscopic cholecystectomy in Child-Pugh class C cirrhotic patients. JSLS 2005;9:311–5.

Qureshi H, Bile KM, Jooma R, Alam SE, Afridi HU. Prevalence of hepatitis B and C viral infections in Pakistan: findings of a national survey appealing for effective prevention and control measures. East Mediterr Health J 2010;16(Suppl):S15–23.

Puggioni A, Wong LL. A metaanalysis of laparoscopic cholecystectomy in patients with cirrhosis. J Am Coll Surg 2003;197:921–6.

Genc V, Sulaimanov M, Cipe G, Basceken SI, Erverdi N, Gurel M, et al. What necessitates the conversion to open cholecystectomy? A retrospective analysis of 5164 consecutive laparoscopic operations. Clinics (Sao Paulo) 2011;66:417–20.

Tayeb M, Khan MR, Riaz N. Laparoscopic cholecystectomy in cirrhotic patients: feasibility in a developing country. Saudi J Gastroenterol 2008;14(2):66–9.

Hamad MA, Thabet M, Badawy A, Mourad F, Abdel-Salam M, Abdel-Rahman Mel-T, et al. Laparoscopic versus open cholecystectomy in patients with liver cirrhosis: a prospective, randomized study. J Laparoendosc Adv Surg Tech A 2010;20:405–9

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Published

2013-06-01

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