Laparoscopic cholecystectomy in cirrhotic patients

Schiff, Jonathan D.; Misra, Mahesh C.; Rendón, Gabriel; Rothschild, Janice G.; Schwaitzberg, Steven D.

doi:10.1007/s00464-004-8823-z

Cited by 37 publications

(38 citation statements)

References 11 publications

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“…For patients undergoing laparoscopic cholecystectomy, a preoperative MELD score of 8 was linked to high morbidity, and was suggested as the cutoff value for avoiding the operation in patients with liver cirrhosis [221] . However, Schiff et al [222] recently reported that preoperative platelet levels and PT (international normalized ratio) are more important factors for the safety of cholecystectomy than C-P grade.…”

Section: Risk Of Surgery In Patients With Liver Diseasesmentioning

confidence: 99%

Systemic abnormalities in liver disease

Minemura¹,

Tajiri²,

Shimizu³

2009

WJG

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Section: Risk Of Surgery In Patients With Liver Diseasesmentioning

confidence: 99%

Systemic abnormalities in liver disease

Minemura¹,

Tajiri²,

Shimizu³

2009

WJG

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“…Cholecystectomy and hernia repair surgery are the most frequently described surgeries in LC, and modified laparoscopic techniques have been proposed in these cases in order to minimize morbidity (Table 2) [77][78][79][80][81][82] . The use of laparoscopy allows non-exposure of viscera and restricts electrolytic and protein losses [79] .…”

Section: Surgical Considerationsmentioning

confidence: 99%

“…A wide range of interventions can be performed laparoscopically in LC patients: splenectomies, colectomies, Nissen fundoplication, Heller's myotomy, gastric bypass, radical nephrectomy [88] , appendectomies [89] , suture closure, and placement of an omental patch for treatment of a perforated gastric ulcer [90] . Although, in general, outcomes are poorer in LC patients than in the non-LC population in terms of morbidity and mortality, mortality rates are quite similar in certain surgeries thanks to the technical advances and experience gained in recent years (Table 3) [10,[77][78][79][81][82][83][84][85][86][87]89,[91][92][93][94][95][96][97][98][99][100][101] . One example is abdominal wall surgery.…”

Section: Surgical Considerationsmentioning

confidence: 99%

“…One example is abdominal wall surgery. Elective repair of umbilical hernia in patients with LC and ascites is indicated due to the poor outcomes with conservative management [102][103][104] ; and, even in advanced LC, inguinal hernia repair obtains similar outcomes to those recorded in the non-LC [77] , 1999 Use of open technique using Hassan's trocar Prevent inadvertent puncture of umbilical varix Shiff et al [78] , 2005 Placement of the trocar in the right paramedian position Clark et al [79] , 2001 Use of additional ports Facilitate laparoscopic technique and prevent complications in cases of severe gallbladder inflammation Performance of retrograde cholecystectomy Clark et al [79] , 2001…”

Section: Surgical Considerationsmentioning

confidence: 99%

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Outcomes of abdominal surgery in patients with liver cirrhosis

López-Delgado

Ballús

Esteve

et al. 2016

WJG

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Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes. Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery. In the emergency setting, with the presence of decompensated LC, alcoholic hepatitis, severe/advanced LC, and significant extrahepatic organ dysfunction conservative management is preferred. A multidisciplinary, individualized, and s p e c i a l i z e d a p p r o a c h c a n i m p r o v e o u t c o m e s ; preoperative optimization after risk stratification and careful management are mandatory before surgery. Laparoscopic techniques can also improve outcomes. We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before, during, and after surgery.Key words: Liver cirrhosis; Outcomes; Coagulopathy; Nutritional status; Abdominal surgery; Adaptive levels of expertise of the surgeons, anesthetists, and intensive care unit (ICU) staff. Liver function is usually assessed by the Child-Turcott-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores [11] . Early studies found 30 d mortality rates after surgery were 10% in CTP-A, 30% in CTP-B, and 76%-82% in CTP-C, figures that have not significantly changed in more recent assessments [12,13] . Despite the poor results, advances in the medical management of LC and life expectancy have increased the eligibility of these patients for abdominal surgery [14] . To be able to give definitive recommendations and indications for non-hepatic abdominal surgery in the cirrhotic population, it is important to identify the patients most likely to benefit from it. There is also a need to assess contemporary surgical techniques and the various scoring systems currently in use.This review summarizes the outcomes of patients with LC undergoing non-hepatic abdominal surgery. Indexed articles in Medline of series of patients with LC who underwent non-hepatic abdominal surgery between 1950 and March 2014 were reviewed using the OVID interface. We aimed to select manuscripts addressing outcome based on the degree of LC assessed with MELD and/or CTP scores. Articles addressing the pathophysiology of cirrhotic patients and the clinical implications in non-hepatic abdominal surgery were selected based on their importance, their date of publication, and the citations of the manuscripts. As for articles describing the different types of surgery in LC patients, the most recent publications were selected in order to preser...

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“…In patients with severe liver dysfunction who have to undergo cholecystectomy, laparoscopic cholecystectomy, partial hepatic resection, or other medium or major surgical interventions, there is an association between PT and postoperative bleeding [2,21,43,65]. The purpose of plasma therapy is to raise PT levels to more than 50% [43].…”

Section: Liver Damagementioning

confidence: 99%