Cirrhosis and laparoscopic cholecystectomy

Although cirrhosis has been regarded as a contraindication to laparoscopic cholecystectomy, there is increasing evidence that patients with mild to mo derate cirrhosis may safely undergo laparoscopic cholecystectomy with resul ts superior to those of open cholecystectomy. A prospective evaluation acid comparison of outcome in 25 consecutive patients with cirrhosis and 1275 p atients without cirrhosis undergoing laparoscopic cholecystectomy was under taken. Fourteen patients with Child's A cirrhosis, nine with Child's B, and two with Child's C underwent laparoscopic cholecystectomy. After surgery, one patient with Child's C cirrhosis died. The median length of stay was 4 days. Postoperative morbidity occurred in 52% of patients and included hemo rrhage (8%), thromboembolism (4%), wound complications (24%), intraabdomina l collections (12%), and cardiopulmonary complications (8%). Major comorbid ity was present in 60% of patients and contributed to complication rate and prolonged stay. Hemorrhage (P = 0.04) and wound complications (P = 0.02) o ccurred more frequently in patients with cirrhosis than in patients without cirrhosis. Laparoscopic cholecystectomy in patients with cirrhosis is asso ciated with significant but acceptable morbidity and mortality rates, and c omplications are frequently related to comorbid conditions.