Post-operative morbidity and mortality of laparoscopic cholecystectomy in patients with cirrhosis: a systematic review and meta-analysis.

BACKGROUND

Patients with cirrhosis are at increased risk of gallstone disease. The objective of this review was to assess the literature to better define the perioperative risks for patients with cirrhosis undergoing laparoscopic cholecystectomy.

METHODS

A systematic review was conducted using PRISMA guidelines. Inclusion criteria included papers published since 1990, with at least 25 patients with cirrhosis undergoing cholecystectomy. Outcomes of interest were post-operative liver decompensation, bile leak, surgical site infection (SSI), pneumonia, venous thromboembolism (VTE), transfusions and mortality.

RESULTS

Forty-two papers were included with 24 575 patients, 48 % were female, with mean age of 53 years. Most patients were Child-Turcotte-Pugh A (74 %), followed by B (23 %), and C (3 %). Emergent cholecystectomy was performed in 28.7 % of patients. Post-operative liver decompensation occurred in 7.1 % (0.9-13.3, 95 % CI) of patients, superficial SSI in 1.1 % (0.6-1.5), organ space SSI in 3.7 % (2.0-5.5), bile leak in 0.7 % (0.2-1.1), VTE in 1.8 % (0.7-2.9), pneumonia in 1.9 % (1.2-2.6) and transfusions in 4 % (2.7-5.2). Post-operative mortality was 1.8 % (1.2-2.4).

CONCLUSION

Laparoscopic cholecystectomy is safe in most patients with cirrhosis, with notably higher complication rates compared to the general population. Continued efforts to decrease rates of bile leak, post-operative liver decompensation and mortality should be encouraged.