A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease.

BACKGROUND

The purpose of this study was to compare the risks and benefits of performing open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with compensated cirrhosis.

METHODS

Data on 50 patients who underwent cholecystectomy for the treatment of symptomatic gallstone disease between 1990 and 1997 were collected retrospectively. These patients were divided into 2 groups: Group I included 24 patients who underwent OC, and Group II included 26 patients who underwent LC. The cohorts were well-matched for age, sex, race, clinical presentation, and Child-Turcotte-Pugh (CTP) class. Twelve patients in Group I had a concomitant surgical procedure in contrast to only 2 patients in Group II. No patient in this study had CTP Class C cirrhosis.

RESULTS

There was no operative mortality. Conversion to OC was necessary in 3 patients (12%) during LC because of uncontrollable liver bed bleeding in 2 of the patients and insufficient visualization of the anatomy in 1 of the patients. Mean surgical times were significantly longer in Group I when comparing patients from both groups without concomitant surgical procedures (mean +/- SD, 177 +/- 91.3 minutes vs 116.8 +/- 42.3 minutes, P = .037). No patient in Group II required any blood component replacement in contrast to 9 patients (38%) in Group I. Intraoperative bleeding remained significantly higher in Group I when comparing patients without concomitant surgical procedures (P = .043). No patients in Group II had a wound complication, compared with 2 patients (8%) in Group I. The 12 patients without concomitant surgical procedures in Group I had significantly longer hospital stays when compared with 24 patients without concomitant surgical procedures in Group II (mean +/- SD, 6.9 days +/- 3.3 [median 6] vs 2.4 days +/- 1.8 [median 2.0]); P = .001.

CONCLUSIONS

Our results demonstrate that laparoscopic cholecystectomy can be performed safely in patients with CTP Class A and B cirrhosis. It offers several advantages over open cholecystectomy, including lower morbidity, shorter operative time, and reduced hospital stay with less need for transfusions.