Eduardo B V da Silveira1. 1. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA. eda_silveira@stanford.edu
Abstract
BACKGROUND AND AIM: Cholelithiasis is a common finding in patients with cirrhosis. Previous studies showed that open cholecystectomy (OC) carries a high risk of postoperative complications and deaths in cirrhotic patients. Laparoscopic cholecystectomy (LC) has significantly decreased hospital stay and postoperative morbidity in non-cirrhotic patients. The aim of this study was to evaluate the outcomes of cirrhotic patients after LC and OC in a tertiary center. METHODS: The outcomes of 33 cirrhotic patients matched by age and sex to 66 non-cirrhotic controls who underwent cholecystectomy were assessed using Bayesian analysis. Both non-informative and informative priors were used to calculate posterior distributions for parameters under investigation. RESULTS: Twenty-four (72%) cirrhotic patients had LC and 9 (27%) OC. A similar percentage of patients in the control group underwent LC (78%) and OC (21%). Emergent cholecystectomy was not different between cirrhotic and controls (95% credible interval [CrI]-0.35, 0.02). Mean blood loss, duration of surgery and conversion rate was not different between cirrhotic and controls, but cirrhotic patients had a longer length of hospital stay than controls (CrI 0.88, 4.71). Cirrhotic patients undergoing LC had lower volume of blood loss (CrI -363.85 mL, -49.28 mL), shorter duration of surgery (CrI -79.82 min, -19.74 min), lower amount of intravenous fluid during surgery (CrI -1532.9 mL, -495.4 mL) and shorter hospital stay (CrI -11.14 days, -1.20 days) than cirrhotic patients undergoing OC. Child-Pugh class B class and admission diagnosis of biliary pancreatitis were associated with a longer hospital stay. CONCLUSION: Laparoscopic cholecystectomy is a safe and effective alternative to OC in Child-Pugh class A and B cirrhotic patients undergoing elective or emergent cholecystectomy. Although outcomes of cirrhotic patients undergoing LC and OC in a tertiary center are not different, LC is associated with less intraoperative bleeding, shorter duration of surgery and fewer days of in-hospital care.
BACKGROUND AND AIM: Cholelithiasis is a common finding in patients with cirrhosis. Previous studies showed that open cholecystectomy (OC) carries a high risk of postoperative complications and deaths in cirrhoticpatients. Laparoscopic cholecystectomy (LC) has significantly decreased hospital stay and postoperative morbidity in non-cirrhoticpatients. The aim of this study was to evaluate the outcomes of cirrhoticpatients after LC and OC in a tertiary center. METHODS: The outcomes of 33 cirrhoticpatients matched by age and sex to 66 non-cirrhotic controls who underwent cholecystectomy were assessed using Bayesian analysis. Both non-informative and informative priors were used to calculate posterior distributions for parameters under investigation. RESULTS: Twenty-four (72%) cirrhoticpatients had LC and 9 (27%) OC. A similar percentage of patients in the control group underwent LC (78%) and OC (21%). Emergent cholecystectomy was not different between cirrhotic and controls (95% credible interval [CrI]-0.35, 0.02). Mean blood loss, duration of surgery and conversion rate was not different between cirrhotic and controls, but cirrhoticpatients had a longer length of hospital stay than controls (CrI 0.88, 4.71). Cirrhoticpatients undergoing LC had lower volume of blood loss (CrI -363.85 mL, -49.28 mL), shorter duration of surgery (CrI -79.82 min, -19.74 min), lower amount of intravenous fluid during surgery (CrI -1532.9 mL, -495.4 mL) and shorter hospital stay (CrI -11.14 days, -1.20 days) than cirrhoticpatients undergoing OC. Child-Pugh class B class and admission diagnosis of biliary pancreatitis were associated with a longer hospital stay. CONCLUSION: Laparoscopic cholecystectomy is a safe and effective alternative to OC in Child-Pugh class A and B cirrhoticpatients undergoing elective or emergent cholecystectomy. Although outcomes of cirrhoticpatients undergoing LC and OC in a tertiary center are not different, LC is associated with less intraoperative bleeding, shorter duration of surgery and fewer days of in-hospital care.
Authors: Everson L A Artifon; Eduardo B da Silveira; Dayse Aparicio; Jonas Takada; Renato Baracat; Christiano M Sakai; Ruel T Garcia; Vanessa Teich; Decio S Couto Journal: Dig Dis Sci Date: 2011-02-12 Impact factor: 3.199
Authors: Jerome M Laurence; Peter D Tran; Arthur J Richardson; Henry C C Pleass; Vincent W T Lam Journal: HPB (Oxford) Date: 2012-01-18 Impact factor: 3.647
Authors: Jorge Marcelo Padilla Mancero; Luiz Augusto Carneiro D'Albuquerque; Adriano Miziara Gonzalez; Frans Ivan Serpa Larrea; Adavio de Oliveira e Silva Journal: World J Surg Date: 2008-02 Impact factor: 3.352