A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease

J L Poggio, C M Rowland, G J Gores, D M Nagorney, J H Donohue
Surgery 2000, 127 (4): 405-11

BACKGROUND: The purpose of this study was to compare the risks and benefits of performing open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with compensated cirrhosis.

METHODS: Data on 50 patients who underwent cholecystectomy for the treatment of symptomatic gallstone disease between 1990 and 1997 were collected retrospectively. These patients were divided into 2 groups: Group I included 24 patients who underwent OC, and Group II included 26 patients who underwent LC. The cohorts were well-matched for age, sex, race, clinical presentation, and Child-Turcotte-Pugh (CTP) class. Twelve patients in Group I had a concomitant surgical procedure in contrast to only 2 patients in Group II. No patient in this study had CTP Class C cirrhosis.

RESULTS: There was no operative mortality. Conversion to OC was necessary in 3 patients (12%) during LC because of uncontrollable liver bed bleeding in 2 of the patients and insufficient visualization of the anatomy in 1 of the patients. Mean surgical times were significantly longer in Group I when comparing patients from both groups without concomitant surgical procedures (mean +/- SD, 177 +/- 91.3 minutes vs 116.8 +/- 42.3 minutes, P = .037). No patient in Group II required any blood component replacement in contrast to 9 patients (38%) in Group I. Intraoperative bleeding remained significantly higher in Group I when comparing patients without concomitant surgical procedures (P = .043). No patients in Group II had a wound complication, compared with 2 patients (8%) in Group I. The 12 patients without concomitant surgical procedures in Group I had significantly longer hospital stays when compared with 24 patients without concomitant surgical procedures in Group II (mean +/- SD, 6.9 days +/- 3.3 [median 6] vs 2.4 days +/- 1.8 [median 2.0]); P = .001.

CONCLUSIONS: Our results demonstrate that laparoscopic cholecystectomy can be performed safely in patients with CTP Class A and B cirrhosis. It offers several advantages over open cholecystectomy, including lower morbidity, shorter operative time, and reduced hospital stay with less need for transfusions.

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