Low pressure pneumoperitoneum laparocopic cholecystectomy is appropriate procedure for cholecystolithiasis in cirrhotic patients

ABSTRACT

This study aimed to evaluate the feasibility and outcome of laparoscopic cholecystectomy [LC] in cirrhotic patients. All patients presented by symptomatic cholecystolithiasis; the diagnosis was mainly according to the disease history and ultrasound, CT and esophageal barium swallow examination results. Preoperative hepatic function protection and supporting, ascites controlling and portal vein pressure reduction were considered individually for most cases of Child-Pugh [CP] class B and C with attempts to improve the hepatic function of class C patients to near class B level. Only after that, surgical operations arranged were allowed for a safer elective operation. A standard four ports laparoscopic procedure was performed according to the European ifour-puncturet technique using low-pressure pneumoperitoneum [7-9 mmHg]. Conversion rate, duration of surgical procedure, incidence of intra- and postoperative complications, and mean hospital stay were recorded. Patients were followed up for a period of 6 months after surgery. The study included 16 patients; 9 females and 7 males with mean patients' age was 53.5 +/- 5.8; range 42-61 years. Clinical signs included splenomegally in 12 cases [75%], widened po.tal vein with diameter >14 mm in 10 cases [62.5%], ascites in 5 cases [31.3%], varices of esophagus and gastric fundus veins in 6 cases [37.5%]. Eight patients were class A, 7 were class B and one patient was class C. No conversion to open cholecystectomy [OC], need for a second surgical intervention or perioperative mortality occurred. The average surgical procedure duration was 69.2 +/- 1 Imin; 2 patients [12.5%] had liver bed bleeding and required transfusion of one bag of blood during surgery. The mean time to resume diet was 19.6 +/- 5.8 hours and mean hospital stay was 4.3 +/- 1.4 days. Three patients [18.75%] had postoperative complications 2 [12.5%] suffered from ascites leading to a worsening of the CP score in one of them, and the third had ischemic chest pain. It could be concluded that LC at low-pressure pneumoperitonium [7-9 mmHg] is an appropriate line of management of cholecystolithiasis in cirrhotic patients and is associated with no mortality or need for return to operating room and acceptable low morbidity rate