[Cirrhosis and cholelithiasis. Laparoscopic or open cholecystectomy?].

UNLABELLED: Recently laparoscopic cholecystectomy has become the standard operation in case of cholelithiasis. The range of contraindications has decreased, a previous abdominal surgery, a severe cholecystitis or gravidity are not self-evident contraindications any more. The advantages and benefits of laparoscopic interventions in patients with hepatic cirrhosis are doubtful.

PATIENTS AND METHODS: Between 1996--2006, 52 patients were analyzed at the I. Department of Surgery of Semmelweis University in a retrospective study who underwent operations on hepatic cirrhosis and cholelithiasis. The female/male ratio was 2.7/1 and the mean age was 58.5 (31-87). The patients were classified according to the Child-Pugh score: A = 36, B = 14, C = 2. 23 traditional, open (OC) and 29 laparoscopic (LC) cholecystectomy were performed, in 4 out of the latter operations conversion had to be done.

RESULTS: In Child A and B cirrhotic patients the mean operative time was 86.5 minutes in the case of LC, whereas with the open intervention it was 86.21 minutes. In Child C cirrhotic patients, open cholecystectomy was performed in both cases, the average operative time was 81.5 minutes. Postoperative complications (Child A, B) occurred in 8 cases (LC/1), (OC/7), while in Child C patients in two cases. The average hospital stay was 7.6 (LC) and 12.45 (OC) days, respectively. The same with Child C patients increased to 28 days. In the postoperative phase 4 patients died: all of them had open cholecystectomy, suffered from Child B and Child C class hepatic cirrhosis, respectively, and they developed hepatorenal syndrome that could not be treated.

CONCLUSION: The results show that LC is a safe procedure in well-compensated Child A and B cirrhotic patients. Although hepatic cirrhosis greatly increases the surgical risks, as well as the likelihood of complications, and it also necessitates longer operative time and longer hospital stay, it is recommended that cirrhotic patients with symptomatic cholelithiasis should clearly be operated on.