Laparoscopic cholecystectomy and cirrhosis: A case-control study of outcomes

Neville F. Fernandes, Wayne H. Schwesinger, Susan G. Hilsenbeck, Glenn W.W. Gross, Michael K. Bay, Kenneth R. Sirinek, Steven Schenker

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69 Scopus citations

Abstract

The incidence of gallstone disease in patients with cirrhosis is greater than that in healthy patients. Previous surgical literature reported greater morbidity and mortality in patients with cirrhosis with both open and laparoscopic cholecystectomy (LC). We compared our recent experience with LC in patients with cirrhosis and controls. A retrospective review was performed using the search terms, 'cirrhosis' and 'laparoscopic cholecystectomy.' Forty-eight patients with cirrhosis were identified and randomly matched with healthy controls by age and sex. Four controls were assigned per patient with cirrhosis. Outcomes assessed included mortality, duration of surgery, length of hospital stay, blood transfusion requirement, postoperative complications, and need for conversion to open cholecystectomy. Forty-eight patients with cirrhosis and 187 healthy controls underwent LC. Child-Pugh classification of severity of liver disease was as follows: Child's class A, 38 of 48 patients; Child's class B, 10 of 48 patients; and Child's class C, 0 of 48 patients. Patients with cirrhosis had statistically significantly lower albumin levels (P = .0001) and prolonged prothrombin times (P = .05). Average duration of surgery for patients with cirrhosis was 1.71 versus 1.57 hours (P = .57) for controls. Average length of hospital stay for patients with cirrhosis was 6.47 versus 4.77 days (P = .152) for controls. Average number of units of blood transfused in patients with cirrhosis was 0.156 versus 0.0 units (P = .025) in controls. Complications occurred in 6 of 48 patients with cirrhosis (12.5%) and 8 of 187 controls (4.2%; P < .05). No child's class C patient underwent LC. Four patients with cirrhosis (8.3%) and no controls were converted to open cholecystectomy. No postoperative infections were noted. There was no mortality in either group. LC in patients with Child's class A and B cirrhosis is reasonably safe and shows no increase in morbidity or mortality or worsening of outcome. Further studies are required to evaluate the management of acute gallbladder disease in Child's class C patients.

Original languageEnglish (US)
Pages (from-to)340-344
Number of pages5
JournalLiver Transplantation
Volume6
Issue number3
DOIs
StatePublished - May 2000

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ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Fernandes, N. F., Schwesinger, W. H., Hilsenbeck, S. G., Gross, G. W. W., Bay, M. K., Sirinek, K. R., & Schenker, S. (2000). Laparoscopic cholecystectomy and cirrhosis: A case-control study of outcomes. Liver Transplantation, 6(3), 340-344. https://doi.org/10.1053/lv.2000.6353