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 treatmen t of symptomatic gallstone disease between 1990 and 1997 were collected ret rospectively. These patients were divided into 2 groups: Group I included 2 4 patients who underwent OC, and Group II included 26 patients who underwen t LC. The cohorts were well-matched for age, sex, race, clinical presentati on and Child-Turcotte-Pugh (CTP) class. Twelve patients in Group I had a co ncomitant 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 i n 3 patients (12%) during LC because of uncontrollable liver bed bleeding i n 2 of the patients and insufficient visualization of the anatomy in 1 of t he 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). N o patient in. Group II required any blood component replacement in contrast to 9 patients (38%) in Group I. Intraoperative bleeding remained significa ntly higher in Group I when comparing patients without concomitant surgical procedures (P = .043). No patients in Group II had a wound complication, c ompared with 2 patients (8%) in Group I. The 12 patients without concomitan t surgical procedures in Group I had significantly longer hospital stays wh en compared with 24 patients without concomitant surgical procedures in Gro up 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, s horter operative time, and reduced hospital stay with less need for transfu sions.