DEFINITIVE SURGICAL-TREATMENT FOR CHOLELITHIASIS IN SELECTIVE PATIENTS WITH LIVER-CIRRHOSIS

A review of 132 cirrhotic patients with cholelithiasis was carried out . Of the 87 patients who underwent definitive surgical procedures for gallstones, patients of Child's A grade had less operative blood loss, blood transfusion and shorter hospital stay than those of B and C gra des. No mortality in cirrhotic patients with Child's A and B grade was found in both emergency and elective surgery. Emergency operation in patients with Child's C grade resulted in more operative blood loss an d requirement than elective surgery. Patients in this grade had also a higher morbidity rate and four deaths ensued. Of the 83 survivals aft er definitive procedures, 78 patients (93.9%) were still alive in the following 62.8 months without any biliary tract symptoms. Of patients who survived after cholecystolithotomy, 6 patients (33.3%) had recurre nt stones in the same follow-up period. Therefore, we recommend that d efinitive biliary surgery be selectively carried out in cirrhotic pati ents in Child's A and B grade. However, a conservative approach is mor e suitable in Child's C patients in emergency conditions and definitiv e procedures should be considered when their liver function improves.