Laparoscopic cholecystectomy in liver cirrhosis patients: an Egyptian experience

ABSTRACT

Cirrhosis represents a common histologic pathway for a wide variety of chronic liver diseases. Hepatitis C virus [HCV] is the most important cause of liver cirrhosis in Egypt. Although cirrhosis has been regarded as a relative contraindication for laparoscopic cholecystectomy [LC] due to bleeding complications and subsequent liver failure, several reports support the safety of LC in selected patients. A prospective study to evaluate the efficacy and safety of laparoscopic cholecystectomy in cirrhotic patients. 177 hepatitis C positive patients with chronic calculus cholecystitis, scheduled for cholecystectomy, were included in this study between Jan. 2009 and Mar. 2010 where laparoscopic cholecystectomy was performed to them after fulfilling the inclusion criteria. Two risk stratifications schemes have been used to estimate the perioperative risk of patients with cirrhosis; the Child-Turcotte-Pugh [CTP] score and the Model for End-stage Liver Disease [MELD] score. 177 liver cirrhosis patients with chronic calcular cholecystitis scheduled for LC represented the population of this study. All patients were HCV positive patients with Child A class cirrhosis and MELD score < 9. Mean surgical time 55 minutes, surgical difficulty varied between average in 64%, moderate in 28% and extensive in 8% where 3.4% needed conversion to open cholecystectomy. Postoperative follow up of all cases was multidisciplinary approached by both surgeons and hepatologists. All cases showed sound recovery confirmed by abdominal sonar to exclude intra-abdominal collections and application of both CTP and MELD scores, where all cases kept class A Child score and MELD score < 9. Laparoscopic cholecystectomy is a safe procedure for hepatitis C positive cirrhotic patients when established risk stratifications systems such as CTP and MELD scores are used for evaluation