Hakan BULUS, Erdem KOÇAK, Ali COŞKUN, Seyfettin KÖKLÜ

Laparoscopic Cholecystectomy in Cirrhotic Patients with Symptomatic Cholelithiasis

Sirotik hastalarda safra taşları genel popülasyona göre iki kat daha sık görülmektedir. Daha önceleri sirotik hastalarda portal hipertansiyon ve koagülopati varlığı nedeni ile laparoskopik kolesistektomi (LK) kontrendike bir durum olarak kabul edilmekte iken günümüzde uygulanabilir bir prosedür haline gelmiştir. Bu çalışmada Child A ve Child B sirotik olgularda LK’nin güvenilirliğini değerlendirdik. Kasım 2008 ile Ekim 2011 arasında LK yapılan safra kesesi taşı olan sirotik hastalar çalışmaya dahil edildi. Demografik özellikler ve başlangıç başvuru şekli, dönüşüm oranları, komplikasyon oranları, mortalite, hastanede kalış süresi, operasyon süresi gibi diğer parametrede değerlendirildi. Child-Pugh A sirozlu (%76.1) ve Child Pugh B sirozlu (%23.8) toplam 21 hasta’ya (K/E 4/21) LK uygulandı. Hastaların yaş ortalaması 61.1±14. İki hastada (%9.5) postoperatif yara yeri enfeksiyonu gelişirken ortalama hastanede kalış süresi 3.8 gündü. 21 olgudan sadece 2’sinde (%9.5) açık kolesistektomiye geçildi. Ortalama operasyon süresi 82.5±15 dakika idi. İntraoperatif ve post operatif dönemde 3 hastada (14.2%) karaciğer parankim kanaması gözlemlendi. Semptomatik safra kesesi taşı olan kompanse sirotik Child A ve Child B’li olgularda LK güvenilir ve etkili alternatif bir tedavi yöntemidir. Laparosopik yaklaşım daha az kan kaybı, kısa operasyon süresi ve kısa yatış süresi, gibi birçok avantajı olan yaklaşımdır

Anahtar Kelimeler:

Siroz, kolelitiazis, laparoskopik kolesistektomi

Laparoscopic Cholecystectomy in Cirrhotic Patients with Symptomatic Cholelithiasis

Gallstones are twice as common in cirrhotic patients as in the general population. Laparoscopic cholecystectomy (LC) was originally contraindicated in cirrhotic patients because of the associated portal hypertension and coagulopathy. But nowadays, it is not considered contraindicated. This study examined the safety of LC in Child\'s class A-B patients. All the cirrhotic patients with gallstones who underwent LC between September 2008-October 20011 have been included in the study. All the cirrhotic patients with Child-Pugh class A and B cirrhosis undergoing LC were included in the study. Demographic characteristics and other parameters including initial presentation, conversion rate, complication rate, mortality, and duration of hospital stay, timing operative were investigated. 21 patients with Child-Pugh A (76.1%) and Child Pugh B (23.8%), liver cirrhosis, (F/M 4/21) underwent LC. The mean age was approximately 61.1±14 years. Two patients (9.5%) developed postoperative wound infection, and mean hospital stay was 3.8 (2-12) days. Of the 21 cases, 2 (9.5%) were converted to open cholecystectomy. The mean operation time was 82.5±15 minutes. Intra-operative and postoperative complications occurred in 3 patients (14.2%) in the form of liver bed bleeding. LC is a safe and effective alternative for the treatment of symptomatic cholelithiasis in patients with well-compensated Child´s Class A and Class B cirrhosis. The laparoscopic approach offers advantages of less blood loss, shorter operative time, and shorter length of hospitalization in patients with cirrhosis compared to open cholecystectomy.

Keywords:

Cirrhosis, cholelithiasis, laparoscopic cholecystectomy,

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Abdul RS, Ambreen M. Laparoscopic Cholecystectomy in Cirrhotic Patients JSLS 2009;13:592–6.
Morino M, Cavuoti G, Miglietta C, Giraudo G, Simone P. Laparoscopic cholecystectomy in cirrhosis: contrain- dication or privileged indication? Surg Laparosc Endosc 2000;10:360–3.
Soper N. Effects of nonbiliary problems on laparoscopic cholecystectomy. Arch Surg 1993;165:522–6.
Wu Ji, Ling Tang Li. Application of laparoscopic cholecys- 238
Tayeb M, Khan MR, Nazia R. Laparoscopic cholecystecto- my in cirrhotic patients: feasibility in a developing coun- try. Saudi Journal of Gastroenterology 2008;14:66–9.
Yerdel MA, Tsuge H, Mimura H, et al. Laparoscopic chole- cystectomy in cirrhotic patients: expanding indications. SurgLaparosc Endosc 1993;3:180–3.
Gregory A. Eason, Stephen ReMine, Brent Bogard, James Magisano. Laparoscopic Cholecystectomy in Patients With Early Cirrhosis. Current Surgery 2001;58:3 312-5.
Bessa SS, Abdel-Razek AH, Sharaan MA, Bassiouni AE, El- Khishen MA, El- Kayal el SA. Laparoscopic cholecystecto- my in cirrhosis: A prospective randomized study compar- ing the conventional diathermy and the harmonic scalpel for gall bladder dissection. J Laproendosc Adv Surg Tech A 2011;21(1):1–5.
Puggioni A, Wong L. A meta-analysis of laparoscopic cho- lecystectomy in patients with cirrhosis. J Am Coll Surg 2003;197: 921–6.
Quillin RC, Burns JM, Pineda JA, et al. Laparoscopic cho- lecystectomy in the cirrhotic patient: Predictors of out- come. Surgery 2013, 153:634-40
Chinnasamy P, Pidigu SR, Kalpesh J, et al. Laparoscopic cholecystectomy in cirrhotic patients: The role of sub- total cholecystectomy and its variants. J Am Coll Surg 2006;203:145–51.
Machado N. Laparoscopic cholecystectomy in cirrhotics. JSLS. 2012 ;16(3):392-400.