ABSTRACT
Traditionally, cholecystectomy in cirrhotic patients has been reserved for patients with severe biliary disease, because of the high morbidity and mortality in cirrhotic patients undergoing this procedure. Laparoscopic cholecytectomy (LC) was originally contraindicated in cirrhotic patients because of the associated portal hypertension and coagulopathy. This study examined the safety of LC in Child's class A patients.A review was conducted of all patients with cirrhosis who underwent cholecystectomy at our hospital between 1990 and 1998.Fifteen patients with cirrhosis had their gallbladder removed laparoscopically during that time period. All patients were Child's class A. The average age was 59 (range, 36-85). The operative indications included acute cholecystitis (5 patients), biliary pacreatitis (4 patients), biliary colic (5 patients), and cholangitis (1 patients). Six patients had known cirrhosis, and 9 were examined intraoperatively. The average operative time was 105 minutes. None of the patients required a blood transfusion. No intraoperative or postoperative complications occurred. No deaths occurred. Postoperative stay was 3 days or less in all but 3 patients.These results compare favorably to other published studies from outside of the United States. Based on our findings, we believe LC can be performed safely in patients with class A cirrhosis.
ABSTRACT
Historically, hepatic portal vein gas has been linked with a dismal prognosis. However, in the last 3 decades, identification of hepatic portal vein gas has undergone a transition from late recognition on roentgenograms to earlier identification on computed tomography scan. The 5 patients in this case series were found to harbor hepatic portal vein gas identified using computed tomography scan. Eighty percent of the patients had concomitant pathology identified by computed tomography, felt to be the cause of the hepatic portal vein gas. All patients were taken to the operating room for exploration and resection of the offending pathology. All 5 patients survived. We suggest that early recognition using computed tomography scan, with appropriate operative intervention, improves the chance for patient survival when hepatic portal vein gas is identified.
ABSTRACT
The importance of a history of self-administration of drugs intravenously was evaluated in 507 consecutive inpatient male primary alcoholics and primary drug abusers with secondary alcoholism. The subjects were divided into three groups: Group 1 comprised 47 alcoholic men who had primary drug abuse, Group 2 comprised 42 primary alcoholics who used drugs intravenously but did not meet other diagnostic criteria for drug abuse, and Group 3 comprised 418 primary alcoholics who neither met diagnostic criteria for drug abuse nor had taken drugs intravenously. Interviews at the time of entry into the treatment program included the patient and two resource persons; follow-up was complete in 96% of the original sample. Subjects who did not meet research criteria for drug abuse but had taken drugs intravenously more closely resembled the primary drug abusers than they did the primary alcoholics in regard to the course of problems before entering treatment and the 1-year outcome.
