Our Summary

This research paper is about a study conducted on patients with liver cirrhosis (a disease where the liver doesn’t function properly due to long-term damage) who underwent a laparoscopic cholecystectomy. A laparoscopic cholecystectomy is a minimally invasive surgery to remove the gallbladder, and is the preferred method for patients with cirrhosis who also have gallbladder disease or acute gallbladder inflammation.

The researchers performed 111 of these surgeries over a ten year period, focusing on patients with varying severity of liver cirrhosis, classified as Child-Pugh A, B, and C. They found that about a quarter of these surgeries were challenging due to the presence of many blood vessels in the area under the liver. There were also more intraoperative incidents (problems occurring during the surgery) compared to surgeries carried out on other patient groups.

The rate at which they had to switch from the laparoscopic (minimally invasive) approach to open surgery was about 6.3%. The average surgery time was 84 minutes and patients stayed in the hospital for about 4.7 days. About 16.2% of patients experienced complications, such as bleeding, fluid build-up in the abdomen, and wound issues, especially those with more severe cirrhosis (Child-Pugh B and C). The study concluded that the success of the surgery and patient outcome depended on the management of the liver function around the time of the operation.

FAQs

  1. What is the standard procedure for patients with cirrhosis and symptomatic gallbladder disease or acute cholecystitis?
  2. How does the Child-Pugh score predict morbidity in patients with cirrhosis undergoing laparoscopic cholecystectomy?
  3. What were the common complications experienced by patients with cirrhosis after undergoing laparoscopic cholecystectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cholecystectomy is to follow post-operative care instructions carefully, including taking prescribed medications, avoiding heavy lifting or strenuous activities, and sticking to a low-fat diet to prevent complications and aid in a smooth recovery. It is also important to attend follow-up appointments to monitor healing and address any concerns.

Suitable For

Patients with cirrhosis and symptomatic gallbladder disease or acute cholecystitis are typically recommended cholecystectomy. The Child-Pugh score is used as a predictor of morbidity in these patients. In this study, laparoscopic cholecystectomy was performed in 111 cirrhotic patients with Child-Pugh scores of A, B, and C. Intraoperative difficulty was experienced in nearly 30% of patients, with highly vascular sub hepatic adherences reported in a quarter of all cases. Intraoperative incidents were more common in cirrhotic patients compared to other patient groups, and the conversion rate to open cholecystectomy was 6.3%. The morbidity rate was 16.2%, with complications such as bleeding, intraabdominal fluid collections, and wound complications more common in patients with Child-Pugh Cirrhosis B and C. Perioperative management of liver function is crucial for optimal outcomes in these patients.

Timeline

  • Patient experiences symptoms of gallbladder disease such as abdominal pain, nausea, and vomiting
  • Patient undergoes diagnostic tests such as ultrasound or CT scan to confirm diagnosis
  • Patient consults with a surgeon to discuss treatment options, including cholecystectomy
  • Patient undergoes preoperative evaluation and preparation for surgery
  • Patient undergoes laparoscopic cholecystectomy procedure
  • Intraoperative difficulties may be encountered, such as highly vascular sub hepatic adherences
  • Intraoperative incidents may occur, leading to potential conversion to open cholecystectomy
  • Mean operative time is 84 minutes
  • Patient is discharged from the hospital after an average stay of 4.7 days
  • Postoperative complications such as bleeding, fluid collections, and wound complications may occur
  • Morbidity rate is 16.2%, with higher rates in patients with Child-Pugh Cirrhosis B and C
  • Results are dependent on perioperative management of liver function.

What to Ask Your Doctor

  1. What is the reason for recommending a cholecystectomy in my case?
  2. What are the risks and potential complications associated with the surgery, especially considering my cirrhosis?
  3. How will my liver function be monitored before, during, and after the surgery?
  4. Will my cirrhosis impact the surgical technique or recovery process?
  5. What is the expected recovery time and post-operative care plan for someone with cirrhosis undergoing cholecystectomy?
  6. Are there any specific dietary or lifestyle changes I should make before or after the surgery to support my liver health?
  7. How will my cirrhosis impact the anesthesia and pain management during the surgery?
  8. Are there any alternative treatments or procedures that may be considered in my case due to my cirrhosis?
  9. What is the long-term outlook for someone with cirrhosis who undergoes cholecystectomy?

Reference

Authors: Târcoveanu E, Vasilescu A, Lupaşcu C, Vlad N, Moraru M, Stanciu C, Bejan V, Bradea C. Journal: Chirurgia (Bucur). 2020 Mar-Apr;115(2):213-219. doi: 10.21614/chirurgia.115.2.213. PMID: 32369725