Abstracts
1998 Digestive Disease Week

#2324

EVALUATION OF LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH HEPATIC CIRRHOSIS: A FIVE YEAR EXPERIENCE. C. Friel, J. Stack, R.A. Forse, T. Babineau Department of Surgery. Beth Israel Deaconess Hospital. Harvard Medical School. Boston, MA.

To evaluate the safety, efficacy and conversion rate of laparoscopic cholecystectomy in patients with hepatic cirrhosis. Hepatic cirrhosis has been considered a relative contraindication to laparoscopic cholecystectomy according to a 1992 NIH consensus statement. Our institution is a tertiary referral center which specializes in hepato-biliary surgery. Therefore, a retrospective analysis was performed on all cirrhotic patients undergoing attempted laparoscopic cholecystectomy (LC) during the period of 1991-1996. The diagnosis of cirrhosis was made by either biopsy or the surgeon's operative description of the liver. A total of 30 patients (26 = Child's A, 4 = Child's B) underwent attempted laparoscopic cholecystectomy (LC) and 4 patients were converted (CC) to open (conversion rate = 13%). Of the 4 converted patients, 1 had Child's B and 3 had Child's A cirrhosis. The reasons for conversion were severe inflammation and unclear anatomy: no patient was converted due to hemorrhage. There were no complications related to laparoscopy and there were no deaths in this group. Operative time was not significantly greater in the group that was converted (155 ± 30 minutes (CC) vs. 136 ± 35 minutes (LC), p = NS) Laparoscopic cholecystectomy in patients with Child's A or B cirrhosis is safe, associated with a 13% conversion rate and contrary to a 1992 NIH consensus statement, should be considered the primary choice for patients with early cirrhosis.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.