Application of laparoscopic cholecystectomy in patients with cirrhotic portal hypertension

BACKGROUND: Laparoscopic cholecystectomy (LC) has been widely adopted in treating benign gallbladder disea- ses. Cirrhosis and cirrhotic portal hypertension (CPH) are contraindicated for LC in its early period. In recent years, several studies have reported liberal use of LC in patients with cirrhosis. But its benefits and successful use in patients with CPH are less documented. This study was designed to evaluate the feasibility, safety and technical characteristics of LC in CPH patients. METHODS: In 38 patients with symptomatic gallbladder disease and CPH, 19 belonged to Child A class, 15 Child B class and 4 Child C class. Perioperative data of these pa- tients were collected and analyzed. RESULTS: LC was successfully performed in 36 patients, and 2 patients (5.3%) were converted to open cholecystec- tomy (OC) for difficulty in management of bleeding under laparoscopy and dense adhesion of Calot' s triangle. The sur- gical time was 62.6±15.2 minutes. The estimated amount of intraoperative hemorrhage was 75.5±15.5 ml. No blood transfusion was necessary. The time to resume diet was 18.3 ±6.5 hours. Seven postoperative complications in 5 patients (13.2%) included port-site infection (1 patient), respiratory infection (2), upper digestive tract bleeding (1), slight hepatic encephalopathy (1) and increased ascites (2). All patients were cured and discharged from the hospital within 5.6±2.4 days after LC. CONCLUSIONS: Despite LC is difficult for CPH patients, it is feasible and relatively safe. To make LC successful in patients with CPH, it is necessary for surgeons to acquaint with the technical characteristics of LC and emphasize me- ticulous perioperative management.