Article

Laparoscopic cholecystectomy in cirrhotic patients: the role of subtotal cholecystectomy and its variants.

Department of GI and Minimal Access Surgery, Gem Hospital, Coimbatore, Tamilnadu, India.
Journal of the American College of Surgeons (impact factor: 4.55). 09/2006; 203(2):145-51. DOI:10.1016/j.jamcollsurg.2006.04.019 pp.145-51
Source: PubMed

ABSTRACT Open cholecystectomy is associated with considerable morbidity and mortality in cirrhotic patients. Laparoscopic cholecystectomy may offer a better option because of the magnification available and the availability of newer instruments like the ultrasonic shears. We present our experience of 265 laparoscopic cholecystectomies and attempt to identify the difficulties encountered in this group of patients.
Between 1991 and 2005, 265 cirrhotic patients of Child-Pugh Classification A and B, with symptomatic gallstones, were subjected to laparoscopic cholecystectomy. We describe here our tailored approach and our techniques of subtotal cholecystectomy.
Features of acute cholecystitis were present in 35.1% of the patients, and 64.9% presented with chronic cholecystitis. In 81.5% of the patients, the diagnosis of cirrhosis was established preoperatively. In 8.3% of the patients, a fundus first method was adopted when the hilum could not be approached despite additional ports. Modified subtotal cholecystectomy was performed in a total of 206 patients. Mean operative time in the subtotal cholecystectomy group was 72 minutes; in the standard group, it was 41 minutes. There was no mortality. In 15% of patients, postoperative deterioration in liver function occurred. Worsening of ascites, port site infection, port site bleeding, intraoperative hemorrhage, bilious drainage, and stone formation in the remnant were the other complications encountered.
Laparoscopic cholecystectomy is a safe and effective treatment for calculous cholecystitis in cirrhotic patients. Appropriate modification of subtotal cholecystectomy should be practiced, depending on the risk factors present, to avoid complications.

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    R Douard, C Lentschener, Y Ozier, B Dousset
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    Mostafa A Hamad, Mostafa Thabet, Abdalla Badawy, Farouk Mourad, Mahmoud Abdel-Salam, Mohammad El-Taher Abdel-Rahman, Mohammad Zein El-Deen Hafez, Tahra Sherif
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    Article: Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review.
    Daniel Henneman, David W da Costa, Bart C Vrouenraets, Bart A van Wagensveld, Sjoerd M Lagarde
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Keywords

265 cirrhotic patients
 
265 laparoscopic cholecystectomies
 
additional ports
 
bilious drainage
 
cirrhotic patients
 
intraoperative hemorrhage
 
laparoscopic cholecystectomy
 
magnification available
 
Mean operative time
 
Modified subtotal cholecystectomy
 
newer instruments
 
Open cholecystectomy
 
port site infection
 
standard group
 
stone formation
 
subtotal cholecystectomy
 
subtotal cholecystectomy group
 
symptomatic gallstones
 
tailored approach
 
ultrasonic shears