Retrospective survey on laparoscopic cholecystectomy in the cirrhotic patient

Cholelitiasis is a common dis- ease in patients with liver cirrhosis, mainly due to intravascular haemolysis and functional alter- ations of the gallbladder. In Child A and B cir- rhotics laparoscopic cholecystectomy (LC) demonstrated the same advantages and safety as in the non cirrhotic patients. On the contrary, indications for surgery in Child C patients should be carefully evaluated. Nevertheless, the current number of patients with Child C cirrho- sis submitted to LC is too low to extrapolate de- finitive data. Here we report our observations on a retrospective case series of LCs performed for symptomatic biliary disease in patients affected with liver cirrhosis.Both medical records and surgical registers were used to collect pre-operative, intra-opera- tive and post-operative data from 40 cirrhotics out of 921 patients operated by laparoscopic cholecystectomy between November 1996 and November 2006.All patients underwent LC because of symp- tomatic disease. The average duration of the laparoscopic intervention was 111 minutes (60-220 minutes) distributed as follows ac- cording to the severity of liver disease: 66 minutes (48-87) in the Child A group, 108 min- utes (91-119) in the Child B group and 138 minutes (110-160) as refers to Child C cir- rhotics. Median blood loss was quantified as 80 ml (28-97) in Child A group, 155 ml (130- 180) in Child B group and 300 ml (220-500) among Child C cirrhotics. The median length of hospital stay was 6 days (3-9 days) in the Child A group, 9 days (7-13 days) in the Child B group and 21 days (16-27 days) in Child C cirrhotics. Three cases out of 40 (7,5%) died: 2 Child C and 1 Child B.In conclusion, this study confirms that in patients affected with Child A and B cirrhosis LC may be safely performed either in emer- gency or in election whereas as refers to Child C cases we have observed a slightly highermortality but a relevant higher impact of non lethal complications.