SURGERY FOR CHOLELITHIASIS IN CIRRHOTIC-PATIENTS

Although biliary tract surgery for cholelithiasis is performed frequen tly in Japan, cirrhotic patients require special consideration. Postop erative complications after biliary tract surgery were studied in 23 p atients with liver cirrhosis and associated cholelithiasis, 9 of whom had no complications, 8 had minor complications, and 6 had severe comp lications. Concerning the relation between Child's classification and postoperative complications, no complications were seen in four Child' s type A patients, but seven of ten (70%) Child's type B patients and seven of nine (78%) Child's type C patients developed complications. T wo (20%) of the Child's type B patients and four (44%) of the Child's type C were severe, and three of the latter group died. Regarding the preoperative laboratory findings, significant differences were seen be tween the patients without complications and those with severe complic ations in serum bilirubin, albumin, and ICG R15 values. Of the six pat ients with severe complications, five had choledocholithiasis, three o f whom died of liver failure, while two developed biliary peritonitis caused by insufficient fistula formation after removal of the T-tube. Thus, for the treatment of choledocholithiasis in patients with severe cirrhosis, avoiding surgical invasion through the use of such techniq ues as endoscopic papillotomy is recommended whenever possible.