COMPARATIVE STUDY
JOURNAL ARTICLE

Outcome of cirrhotic patients undergoing cholecystectomy: applying Bayesian analysis in gastroenterology

Eduardo B V da Silveira
Journal of Gastroenterology and Hepatology 2006, 21 (6): 958-62
16724978

BACKGROUND AND AIM: Cholelithiasis is a common finding in patients with cirrhosis. Previous studies showed that open cholecystectomy (OC) carries a high risk of postoperative complications and deaths in cirrhotic patients. Laparoscopic cholecystectomy (LC) has significantly decreased hospital stay and postoperative morbidity in non-cirrhotic patients. The aim of this study was to evaluate the outcomes of cirrhotic patients after LC and OC in a tertiary center.

METHODS: The outcomes of 33 cirrhotic patients matched by age and sex to 66 non-cirrhotic controls who underwent cholecystectomy were assessed using Bayesian analysis. Both non-informative and informative priors were used to calculate posterior distributions for parameters under investigation.

RESULTS: Twenty-four (72%) cirrhotic patients had LC and 9 (27%) OC. A similar percentage of patients in the control group underwent LC (78%) and OC (21%). Emergent cholecystectomy was not different between cirrhotic and controls (95% credible interval [CrI]-0.35, 0.02). Mean blood loss, duration of surgery and conversion rate was not different between cirrhotic and controls, but cirrhotic patients had a longer length of hospital stay than controls (CrI 0.88, 4.71). Cirrhotic patients undergoing LC had lower volume of blood loss (CrI -363.85 mL, -49.28 mL), shorter duration of surgery (CrI -79.82 min, -19.74 min), lower amount of intravenous fluid during surgery (CrI -1532.9 mL, -495.4 mL) and shorter hospital stay (CrI -11.14 days, -1.20 days) than cirrhotic patients undergoing OC. Child-Pugh class B class and admission diagnosis of biliary pancreatitis were associated with a longer hospital stay.

CONCLUSION: Laparoscopic cholecystectomy is a safe and effective alternative to OC in Child-Pugh class A and B cirrhotic patients undergoing elective or emergent cholecystectomy. Although outcomes of cirrhotic patients undergoing LC and OC in a tertiary center are not different, LC is associated with less intraoperative bleeding, shorter duration of surgery and fewer days of in-hospital care.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
16724978
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"