Laparoscopic cholecystectomy and cirrhosis: A case-control study of outcomes

The incidence of gallstone disease in patients with cirrhosis is greater th an that in healthy patients. Previous surgical literature reported greater morbidity and mortality in patients with cirrhosis with both open and lapar oscopic cholecystectomy (LC). We compared our recent experience with LC in patients with cirrhosis and controls. A retrospective review was performed using the search terms, "cirrhosis" and "laparoscopic cholecystectomy." For ty-eight patients with cirrhosis were identified and randomly matched with healthy controls by age and sex. Four controls were assigned per patient wi th cirrhosis. Outcomes assessed included mortality, duration of surgery, le ngth of hospital stay, blood transfusion requirement, postoperative complic ations, and need for conversion to open cholecystectomy. Forty-eight patien ts with cirrhosis and 187 healthy controls underwent LC. Child-Pugh classif ication of severity of liver disease was as follows: Child's class A, 38 of 48 patients; Child's class B, 10 of 48 patients; and Child's class C, 0 of 48 patients. Patients with cirrhosis had statistically significantly lower albumin levels (P = .0001) and prolonged prothrombin times (P = .05), Aver age duration of surgery for patients with cirrhosis was 1.71 versus 1.57 ho urs (P = .57) for controls. Average length of hospital stay for patients wi th cirrhosis was 6.47 versus 4.77 days (P = .152) for controls, Average num ber of units of blood transfused in patients with cirrhosis was 0.156 versu s 0.0 units (P = .025) in controls. Complications occurred in 6 of 48 patie nts with cirrhosis (12.5%) and 8 of 187 controls (4.2%; P < .05). No child' s class C patient underwent LC. Four patients with cirrhosis (8.3%) and no controls were converted to open cholecystectomy. No postoperative infection s were noted. There was no mortality in either group. LC in patients with C hild's class A and B cirrhosis is reasonably safe and shows no increase in morbidity or mortality or worsening of outcome. Further studies are require d to evaluate the management of acute gallbladder disease in Child's class C patients.