[Laparoscopic cholecystectomy in patients with liver cirrhosis].

BACKGROUND

Initially considered a contraindication to the surgical laparoscopy, cirrhosis have been an occasional discovery during this procedure. Until now many series reported in the literature suggest that the majority of the surgeons still consider cirrhosis as contraindication to the laparoscopic cholecystectomy.

AIM: To evaluate our experience in laparoscopic treatment of the cholelithiasis in cirrhotic patient.

PATIENTS AND

METHODS

Six hundred and four patients with symptomatic cholelithiasis were operated on Clinical and Surgical Gastroenterology Unit, "Santa Casa de Misericórdia de Porto Alegre", Porto Alegre, RS, Brazil, during the period from May 1993 to May 2000. Of these, 10 (1,6%) presented hepatic cirrhosis. The patients' age was between 22 and 69 years (average of 50,4 +/- 18,1). Eight patients (80%) were female. The alcohol was the etiological factor in four, chronic hepatitis B and C, primary biliary cirrhosis and of alfa-1 antitripsin deficiency in one patient each. In two patient the causal agent was not identified.

RESULTS

Cholecystectomy was accomplished in all patients and in seven also diagnostic hepatic biopsy. In two (20%) the surgery was converted. The result of the intraoperative cholangiography was normal in all cases. In seven patients the postoperative was uneventfull. Clinically controlled ascite was observed in two (20%). Both were Child A at the moment of the surgery. The last patient, Child C, died. He presented irreversible hepatic failure.

CONCLUSIONS

Despite larger experience still should be acquired, it seems that laparoscopic is a safe approach in well compensated cirrhotic patients with symptomatic cholelithiasis. In Child C patients we believed that all of the efforts should be driven to the improvement of the hepatic function or a less invasive method such as cholecystostomy.