Laparoscopic Cholecystectomy in Cirrhotic Patients with Symptomatic Cholelithiasis: A Case‐control Study

Abstract

These results indicate that videolaparoscopic cholecystectomy may be safely performed in public hospitals in Brazil, with low levels of complications, no associated mortality, and no need for blood derivatives.

SAGES guidelines for the clinical application of laparoscopic biliary tract surgery

“…Since the NIH consensus conference on gallstones and laparoscopic cholecystectomy in 1992 suggested that patients with cirrhosis were ''not usually candidates for laparoscopic cholecystectomy'' [1] studies continue to be published supporting the safety of the approach in patients with Child's A or B cirrhosis (including downgrading from C after appropriate treatment) [39] with almost no data using the Model for EndStage Liver Disease (MELD) score to compare patients [139]; though there is little published data for Child's C patients, what is available suggests it should be avoided in favor of nonoperative approaches such as percutaneous cholecystostomy [140]. Recent studies generally agree that laparoscopic cholecystectomy in selected cirrhotics has a relatively low conversion rate (0-11%), complication rate (9.5-21%), and risk of dying (0-6.3%), with most showing worsening liver failure, including the presence of ascites and coagulopathy, predicting poorer outcomes [139][140][141][142][143][144]; a recent prospective randomized trial found that laparoscopic cholecystectomy was safer than open cholecystectomy in cirrhotics [145]. Some authors have suggested laparoscopic subtotal cholecystectomy as an alternative to laparoscopic cholecystectomy [146,147].…”

Laparoscopic Cholecystectomy in Cirrhotics

“…9,10,13–15 A low threshold for conversion to open cholecystectomy should be maintained. Conversion should not be considered as a failure to achieve a difficult task, but a reflection of sound judgment, because it is meant to prevent more serious complications.…”

“…Uncertainty of safety and efficiency warrants an immediate conversion to an open procedure. 10,13–15 …”

“…7,15,17 It will facilitate monitoring the postoperative bleeding. However drainage of the liver bed, in the postsurgery stage is, however, controversial.…”

“…However drainage of the liver bed, in the postsurgery stage is, however, controversial. 1,15,17 This is mainly because of the concern about cirrhotic patients developing ascites and secondary infection. The manipulation of the gallbladder during operation and possibly decreased function of Kupffer cells and inefficient clearing of enteric micro-organisms in the postoperative period, may be the contributing factors leading to secondary infection of ascites and peritonitis.…”