Elective cholecystectomy in selected cirrhotic patients.

Of the 53 cirrhotic patients with cholelithiasis observed at our Institution from 1978 to 1991, 31 were operated on. Twenty-eight Child-Pugh class A, two class B and one class C patients underwent elective cholecystectomy with (5 cases) or without (26 cases) common bile duct exploration. Among the symptomatic patients, nine (18.7%) were refused for surgery because the risk was estimated to be too high. Symptoms ranged from mild-moderate abdominal pain to typical biliary colic. Acute biliary inflammatory complications as cholecystitis or cholangitis could be detected in the clinical history of 5 patients (16%). Although a common clinical feature, jaundice was directly related to gallbladder or common bile duct stones only in one half of the cases. A total of 18 postoperative non-lethal complications occurred in ten patients (32.2%), with haemorrhage from the gallbladder bed being the most frequent event. Bleeding was associated with increased prothrombin time more than 1.5 seconds above the control (p < 0.01) but severe haemorrhage occurred only when the platelet count was less than 100.000/ml (p < 0.05). Common bile duct explorations increased the risk of bleeding. Two of the 3 class B or C patients developed ascites (p < 0.05). It is concluded that elective cholecystectomy can be performed without mortality in selected and symptomatic patients with adequate hepatic functional reserve.