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Laparoscopic Cholecystectomy in Cirrhotics
BACKGROUND AND OBJECTIVES: Due to the concern of risk of intra- and postoperative complications and associated morbidity, cirrhosis of the liver is often considered a contraindication for laparoscopic cholecystectomy (LC). This article intends to review the literature and underline the various appro...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Society of Laparoendoscopic Surgeons
2012
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535789/ https://www.ncbi.nlm.nih.gov/pubmed/23318064 http://dx.doi.org/10.4293/108680812X13462882736493 |
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author | Machado, Norman Oneil |
author_facet | Machado, Norman Oneil |
author_sort | Machado, Norman Oneil |
collection | PubMed |
description | BACKGROUND AND OBJECTIVES: Due to the concern of risk of intra- and postoperative complications and associated morbidity, cirrhosis of the liver is often considered a contraindication for laparoscopic cholecystectomy (LC). This article intends to review the literature and underline the various approaches to dealing with this technically challenging procedure. METHODS: A Medline search of major articles in the English literature on LC in cirrhotic patients over a 16-y period from 1994 to 2011 was reviewed and the findings analyzed. A total of 1310 cases were identified. RESULTS: Most the patients who underwent LC were in Child-Pugh class A, followed by Child-Pugh classes B and C, respectively. The overall conversion rate was 4.58%, and morbidity was 17% and mortality 0.45%. Among the patients who died, most were in Child-Pugh class C, with a small number in classes B and A. The cause of death included, postoperative bleeding, liver failure, sepsis, duodenal perforation, and myocardial infarction. A meta-analysis of 400 patients in the literature, comparing outcomes of patients undergoing LC with and without cirrhosis, revealed higher conversion rate, longer operative time, higher bleeding complications, and overall increased morbidity in patients with cirrhosis. Safe LC was facilitated by measures that included the use of ultrasonic shears and other hemostatic measures and using subtotal cholecystectomy in patients with difficult hilum and gallbladder bed. CONCLUSIONS: Laparoscopic cholecystectomy can be safely performed in cirrhotic patients, within Child-Pugh classes A and B, with acceptable morbidity and conversion rate. |
format | Online Article Text |
id | pubmed-3535789 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | Society of Laparoendoscopic Surgeons |
record_format | MEDLINE/PubMed |
spelling | pubmed-35357892013-01-08 Laparoscopic Cholecystectomy in Cirrhotics Machado, Norman Oneil JSLS Scientific Papers BACKGROUND AND OBJECTIVES: Due to the concern of risk of intra- and postoperative complications and associated morbidity, cirrhosis of the liver is often considered a contraindication for laparoscopic cholecystectomy (LC). This article intends to review the literature and underline the various approaches to dealing with this technically challenging procedure. METHODS: A Medline search of major articles in the English literature on LC in cirrhotic patients over a 16-y period from 1994 to 2011 was reviewed and the findings analyzed. A total of 1310 cases were identified. RESULTS: Most the patients who underwent LC were in Child-Pugh class A, followed by Child-Pugh classes B and C, respectively. The overall conversion rate was 4.58%, and morbidity was 17% and mortality 0.45%. Among the patients who died, most were in Child-Pugh class C, with a small number in classes B and A. The cause of death included, postoperative bleeding, liver failure, sepsis, duodenal perforation, and myocardial infarction. A meta-analysis of 400 patients in the literature, comparing outcomes of patients undergoing LC with and without cirrhosis, revealed higher conversion rate, longer operative time, higher bleeding complications, and overall increased morbidity in patients with cirrhosis. Safe LC was facilitated by measures that included the use of ultrasonic shears and other hemostatic measures and using subtotal cholecystectomy in patients with difficult hilum and gallbladder bed. CONCLUSIONS: Laparoscopic cholecystectomy can be safely performed in cirrhotic patients, within Child-Pugh classes A and B, with acceptable morbidity and conversion rate. Society of Laparoendoscopic Surgeons 2012 /pmc/articles/PMC3535789/ /pubmed/23318064 http://dx.doi.org/10.4293/108680812X13462882736493 Text en © 2012 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way. |
spellingShingle | Scientific Papers Machado, Norman Oneil Laparoscopic Cholecystectomy in Cirrhotics |
title | Laparoscopic Cholecystectomy in Cirrhotics |
title_full | Laparoscopic Cholecystectomy in Cirrhotics |
title_fullStr | Laparoscopic Cholecystectomy in Cirrhotics |
title_full_unstemmed | Laparoscopic Cholecystectomy in Cirrhotics |
title_short | Laparoscopic Cholecystectomy in Cirrhotics |
title_sort | laparoscopic cholecystectomy in cirrhotics |
topic | Scientific Papers |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535789/ https://www.ncbi.nlm.nih.gov/pubmed/23318064 http://dx.doi.org/10.4293/108680812X13462882736493 |
work_keys_str_mv | AT machadonormanoneil laparoscopiccholecystectomyincirrhotics |