Our Summary

This research paper looked into the standard procedure for patients with liver disease (cirrhosis) and gallbladder problems, which is known as laparoscopic cholecystectomy. It’s a type of surgery where the gallbladder is removed using a tiny camera and special surgical tools. The researchers analyzed how well patients with different stages of liver disease (as measured by the Child-Pugh score) fared with this procedure.

The study was conducted over a decade, from 2010 to 2020, at the First Surgical Clinic of Iasi. They performed this surgery on 111 patients with varying degrees of liver disease. They found that the surgery was more challenging in about 29% of the patients and that about a quarter of all patients had excessive blood vessels in the area beneath the liver.

The surgery was more likely to have complications in these patients than in other groups of patients. In fact, in about 6% of cases, they had to switch to an open surgery, which is a more traditional type of surgery that involves a larger incision. On average, the surgery took about 84 minutes, and patients stayed in the hospital for almost 5 days.

The study also found a complication rate of about 16%, including issues like bleeding, fluid collection in the abdomen, and wound complications. These were more common in patients with more advanced liver disease (Child-Pugh Cirrhosis B and C). The authors concluded that the success of this surgery in patients with liver disease greatly depends on how well the liver function is managed around the time of the operation.

FAQs

  1. What is the gold standard procedure for patients with cirrhosis and symptomatic gallbladder disease or acute cholecystitis?
  2. What are the common post-operative complications experienced by patients with Child-Pugh Cirrhosis B and C who have undergone laparoscopic cholecystectomy?
  3. What was the conversion rate to open cholecystectomy in the study conducted at the First Surgical Clinic of Iasi?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laparoscopic cholecystectomy is to follow post-operative care instructions carefully, including taking prescribed medications, avoiding heavy lifting or strenuous activity, and attending follow-up appointments to monitor recovery and ensure proper healing. It is important to rest and allow your body to heal properly after surgery to reduce the risk of complications.

Suitable For

Patients who are typically recommended for laparoscopic cholecystectomy include those with cirrhosis and symptomatic gallbladder disease or acute cholecystitis. The Child-Pugh score is used as a predictor of morbidity in these patients. In this retrospective study, laparoscopic cholecystectomy was performed in Child-Pugh A, B, and C cirrhotic patients. Intraoperative difficulties and incidents were more common in cirrhotic patients compared to other patient groups, with a conversion rate to open cholecystectomy of 6.3%. The morbidity rate was 16.2%, with complications more common in patients with Child-Pugh Cirrhosis B and C. The perioperative management of liver function is crucial in achieving successful outcomes in these patients.

Timeline

Before laparoscopic cholecystectomy:

  • Patient presents with symptoms of gallbladder disease, such as abdominal pain, nausea, and vomiting.
  • Patient undergoes diagnostic tests, such as ultrasound or CT scan, to confirm the presence of gallstones.
  • Patient may be advised to follow a special diet or take medication to manage symptoms before surgery.

After laparoscopic cholecystectomy:

  • Patient undergoes a minimally invasive surgery to remove the gallbladder.
  • Surgery typically lasts around 1-2 hours.
  • Patient is monitored in the recovery room before being discharged home the same day or the next day.
  • Patient may experience some pain and discomfort in the abdomen, which can be managed with pain medication.
  • Patient is advised to rest and avoid heavy lifting for a few weeks after surgery.
  • Patient can gradually resume normal activities and diet as tolerated.
  • Patient may follow up with their surgeon for a post-operative appointment to monitor recovery and address any concerns.

What to Ask Your Doctor

  1. What are the risks and benefits of laparoscopic cholecystectomy for a patient with cirrhosis?
  2. How does my Child-Pugh score affect the likelihood of complications during and after the surgery?
  3. Are there any specific precautions or considerations that need to be taken for a patient with cirrhosis undergoing laparoscopic cholecystectomy?
  4. What is the expected recovery time for a patient with cirrhosis undergoing laparoscopic cholecystectomy?
  5. How will my liver function be monitored before, during, and after the surgery?
  6. Are there any dietary or lifestyle changes I should make to support my liver health after laparoscopic cholecystectomy?
  7. What should I do if I experience any symptoms or complications following the surgery?

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