Laparoscopic Cholecystectomy in Patients with Liver Cirrhosis

Jang, Jin Young; Kim, Ki Whan; Kim, Sun Whe; Park, Yong Hyun

Abstract

Liver cirrhosis is considered as a relative contraindication to laparoscopic cholecystectomy because of a bleeding tendency, the many dilated collateral vessels induced by portal hypertension, and general malnutrition. As experience with laparoscopic operations is accumulated and skills and instruments are developed, the number of conditions known as contraindications to a laparoscopic cholecystectomy is being limited. We compared 26 cases of laparoscopic cholecystectomies(L.C.) with 13 cases of open cholecystectomies(O.C.), which were performed on patients with liver cirrhosis at Seoul National University Hospital from 1992 to 1996. Demographic findings showed no statistical difference between the two groups. The mean operation time was 86 min. in the L.C. group and 117 min. in the O.C. group(p<0.05). The average number of analgesics injections was 5.5 in the O.C. group and 1.2 in the L.C. group(p<0.05). The postoperative hospital stay was 4.7 days in the L.C. group and 13.0 days in the O.C. group(p<0.05). The complication rate was 26.9% in the L.C. group and 46.2% in the O.C. group. When the patients were analyzed according to the Child classification, the patients in Child A had shorter postoperative hospital stays and a lower complication rate than those in Child B or C. Perioperative liver function changes were not significant in either group. In conclusion, liver cirrhosis is not a contraindication to L.C., and, in fact, L.C. should be considered first for the treatment of gallbladder stones in cirrhotic patients.