Laparoscopic cholecystectomy in patients with liver cirrhosis: 8 years experience in a tertiary center. A retrospective cohort study

Abstract

With improved laparoscopic techniques, experience, and availability of newer tools and instruments like ultrasonic shears; laparoscopic cholecystectomy (LC) became a feasible option in cirrhotic patients, the aim of this study was to analyze the outcome of LC in cirrhotic patients.

Methods: We retrospectively analyzed 213 cirrhotic patients underwent LC, in the period from 2011 to 2019; the overall male/female ratio was 114/99.

Results: The most frequent Child-Turcotte-Pugh (CTP) score was A, The most frequent cause of cirrhosis was hepatitis C virus (HCV), while biliary colic was the most frequent presentation. The harmonic device was used in 39.9% of patients, with a significant correlation between it and lower operative bleeding, lower blood and plasma transfusion rates, higher operative adhesions rates, lower conversion to open surgery and 30-day complication rates, shorter operative time and post-operative hospital stays where operative adhesions and times were independently correlated. The 30-day morbidity and mortality were 22.1% and 2.3% respectively while overall survival was 91.5%, higher CTP, and model for end-stage liver disease (MELD) scores, higher mean international normalization ratio (INR) value, lower mean platelet count, higher operative bleeding, higher blood, and plasma transfusion rates, longer mean operative time and postoperative hospital stays were significantly correlated with all conversion to open surgery, 30-day morbidities and mortalities.

Conclusion: LC can be safely performed in cirrhotic patients. However, higher CTP and MELD scores, operative bleeding, more blood and plasma transfusion units, longer operative time, lower platelet count, and higher INR values are predictors of poor outcome that can be improved by proper patient selection and meticulous peri-operative care and by using Harmonic scalpel shears.

Keywords: Harmonic device; Laparoscopic cholecystectomy; Liver cirrhosis.

Fig. 1

(A): Empyema of gallbladder in early cirrhotic liver, (B): Gallbladder decompression by suction device.

Fig. 2

Laparoscopic intraoperativecholangiography

Fig. 3

By using Harmonic device: (A): Dissection of omental adhesions to gallbladder, (B): Dissection at Calot's triangle.

Fig. 4

Dissection of the gallbladder from its cirrhotic liver bed by: (A): Harmonic device (B): hook instrument.

Fig. 5

Haemostasis of cirrhotic liver bed by: (A): Argon, (B): Surgicel.

Fig. 6

(A) Cox Regression 1-month survival curve (B) Kaplan-Meier 1-month survival curve (C) Kaplan-Meier overall survival curve.