Laparoscopic Cholecystectomy in Cirrhotic Patients

Adrian Cotirlet, MD, PhD1, Marius Nedelcu, MD2, Laura Gavril, MD3. 1Moinesti Emergency Hospital, 2Nouvel Hopital Civil, IRCAD, Strasbourg, 3Iasi University Hospital

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for the vast majority of patients with symptomatic cholelithiasis. Although cirrhotic patients are twice as likely to develop gallstones as compared with noncirrhotic patients, cirrhosis has historically been considered a relative, if not absolute, contraindication to laparoscopic cholecystectomy. The aim of our study was to evaluate the results of laparoscopic cholecystectomies in cirrhotic patients.


Methods: The paper represents a retrospective study, which includes 104 patients (2.79%) with hepatic cirrhosis and symptomatic gallstones disease from our experience of 3726 laparoscopic cholecystectomies performed between January 2010 and December 2014. In most of the cases 81 (77.8 %) cirrhosis was diagnosed preoperatively and it was classified CHILD A – 53 cases and B – 28 cases. Retrospective, suggestive for a chronic hepatic disease were patient history (69 cases), transaminase elevations (47 cases), low platelet number (43 cases) and some ecographic findings (39 cases).


Results: There were 39 women and 65 men with mean age of 55 years (range 31- 79). The cirrhosis was classified as macronodular in 68 cases (65.4 %), micronodular in 22 cases (21.15%) and mixt in 14 cases.  Fourteen (13.46 %) of the patients were converted to an open procedure, nine due to excessive hemorrhage from gallblader bed, three to an immobile liver and two cases to impossibility of dissection. The mean operative time was 75 min (35-105 min). Mean length of postoperative stay was 7.64 days (3-21). No reintervention was needed, but one patient necessitated blood transfusion. One case of mortality was recorded.


Conclusion: The analysis of our results demonstrates the efficiency and the safety of laparoscopic cholecystectomy in cirrhotic patients and permits us to sustain this method as the first choice in treatment with symptomatic gallstones in cirrhotic patients.

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