Laparoscopic treatment of cholelithiasis in cirrhotic patients.

OBJECTIVE: To assess the safety and efficacy of laparoscopy in the treatment of symptomatic cholelithiasis in patients with Child's Class A and Class B cirrhosis. STUDY DESIGN: Descriptive and retrospective study. PATIENTS: We studied 14 patients (mean age 60 yrs) with Child's Class A and Class B hepatic cirrhosis who underwent laparoscopic cholecystectomy. We analyzed the occurrence of intraoperative and postoperative complications. RESULTS: Eight patients were women (57.14%) and 6 were men (42.85%). Eight of the 14 patients presented with Child's Class B cirrhosis and 6 patients with Class A. Cholecystectomy was programmed for all patients. The average duration of surgery was 77 min. Intraoperative complications occurred in 2 patients (14.28%) in the form of liver bed bleeding. Postoperative complications were observed in 3 patients (21.42%), 2 presented with ascites which led to a worsening of Child's Class in one of them, and the third patient presented with angina-like symptoms (acute, sharp pain in the chest irradiating to the back). Mean length of hospital stay was 3 days. No postoperative morbidity or mortality occurred, and there were no conversions. CONCLUSIONS: LC (laparoscopic cholecystectomy) is a safe and effective alternative for the treatment of symptomatic cholelithiasis in patients with well-compensated Child's Class A and Class B cirrhosis. Postoperative morbi-mortality is low, bleeding is unimportant, and both duration of surgical procedure and hospital stay are short.

Experiencia en el tratamiento laparoscópico de la colelitiasis del cirrótico / Laparoscopic treatment of cholelithiasis in cirrhotic patients

Objective: to assess the safety and efficacy of laparoscopy inthe treatment of symptomatic cholelithiasis in patients withChild´s Class A and Class B cirrhosis.Study design: descriptive and retrospective study.Patients: we studied 14 patients (mean age 60 yrs) withChild´s Class A and Class B hepatic cirrhosis who underwent laparoscopiccholecystectomy. We analyzed the occurrence of intraoperativeand postoperative complications.Results: eight patients were women (57.14%) and 6 weremen (42.85%). Eight of the 14 patients presented with Child´sClass B cirrhosis and 6 patients with Class A. Cholecystectomywas programmed for all patients. The average duration of surgerywas 77 min. Intraoperative complications occurred in 2 patients(14.28%) in the form of liver bed bleeding. Postoperative complicationswere observed in 3 patients (21.42%), 2 presented withascites which led to a worsening of Child´s Class in one of them,and the third patient presented with angina-like symptoms (acute,sharp pain in the chest irradiating to the back). Mean length ofhospital stay was 3 days. No postoperative morbidity or mortalityoccurred, and there were no conversions.Conclusions: LC (laparoscopic cholecystectomy) is a safe andeffective alternative for the treatment of symptomatic cholelithiasisin patients with well-compensated Child´s Class A and Class Bcirrhosis. Postoperative morbi-mortality is low, bleeding is unimportant,and both duration of surgical procedure and hospital stayare short

Objetivo: evaluar la seguridad y eficacia del uso de la laparoscopiaen pacientes cirróticos en estadio A y B de Child-Pugh concolelitiasis sintomática.Diseño del estudio: estudio descriptivo, retrospectivo.Pacientes: catorce pacientes con una edad media de 60 añosdiagnosticados de cirrosis hepática en estadios A y B que se lespracticó colecistectomía laparoscópica. Se estudia la aparición decomplicaciones intraoperatorias y postoperatorias tras la intervenciónResultados: ocho (57,14%) casos eran mujeres y 6 ( 42,85%)varones. De los 14 pacientes, 8 presentaban un estadio Child-Pugh B y 6 un Child-Pugh A. Todos los pacientes se intervienende colelitiasis de forma programada. El tiempo operatorio mediofue de 77 min. Dos (14,28%) de los pacientes presentaron complicacionesintraoperatorias, sangrado del lecho quirúrgico. Tres(21,42%) pacientes presentaron complicaciones postoperatorias:dos (14,28%) presentaron ascitis con empeoramiento del Child-Pugh en uno de ellos y el otro presentó un cuadro anginoso. Laestancia media de estos pacientes es de 3 días. No hubo ningunamuerte tras la intervención y no hubo ninguna reconversión.Conclusiones: la CL es una alternativa segura y efectiva en eltratamiento de colelitiasis sintomáticas en pacientes con cirrosisen estadio A y B compensada. Ofrece una baja morbimortalidadpostoperatoria con una escasa pérdida de sangre, un tiempo operatoriocorto y una reducida estancia hospitalaria

Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit?

OBJECTIVE: Analysis of clinical and surgical factors in a series of patients subjected to laparoscopic cholecystectomy in an outpatient unit and their relationship with time of discharge and patient acceptance. PATIENTS AND METHOD: Eighty one consecutive patients underwent to elective laparoscopic cholecystectomy during year 2002 within S.A.S. (Andalusian Health Service) from a surgical waiting list. Retrospective and comparative study between two groups: group A includes patients discharged between 24 and 48 hours after intervention; group B includes patients discharged in less than 24 hours. We analyse the clinical and surgical characteristics and post-operative outcome of both groups of patients. RESULTS: Group A was composed of 53 patients and group B of 28 patients. Factors of clinical significance which determined discharge after 24 hours included: early post-surgical incidences or complications (p = 0.017), inability to tolerate oral diet (p = 0.002), and doubts and feelings insecurity of patients regarding discharge by traditional means 62.3% (p = 0.0003). CONCLUSIONS: Outpatient laparoscopic cholecystectomy is a safe and reliable procedure with a high acceptance rate and few complications. Perhaps traditional culture has to be changed to obtain better results.

Colecistectomía laparoscópica en el tratamiento de la litiasis biliar: ¿cirugía mayor ambulatoria o corta estancia? / Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit?

Objetivo: analizar los factores clínicos y quirúrgicos que en una serie de pacientes sometidos a colecistectomía laparoscópica ambulatoria influyeron en la decisión del momento del alta y cuál fue la aceptación de los pacientes al alta. Pacientes y método: en este estudio fueron incluidos 81 pacientes consecutivos procedentes de la lista de espera quirúrgica en quienes se realizó una colecistectomía laparoscópica electiva a lo largo del año 2002. Es un estudio retrospectivo y comparativo que incluye dos grupos de pacientes: los del grupo A fueron dados de alta entre 24 a 48 horas tras la intervención; los del grupo B lo fueron en menos de 24 horas. Analizamos las características clínicas, quirúrgicas y evolución postoperatoria de ambos grupos de pacientes Resultados: el grupo A estaba compuesto por 53 pacientes. El Grupo B por 28 pacientes. Los factores con significación estadística que determinaron que el alta se prolongara más de 24 horas fueron: las incidencias o complicaciones postquirúrgicas precoces (p=0,017), la no tolerancia oral de alimentos (p=0,002) y las dudas o inseguridad de los pacientes ante el alta determinada por la tradición cultural (62,3 por ciento; p=0,0003).Conclusiones: la colecistectomía laparoscópica ambulatoria es un procedimiento seguro y realizable, con un elevado porcentaje de aceptación y escasas complicaciones. Quizás se deba cambiar la tradición cultural para obtener mejores resultados. (AU)