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A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease

Background: The purpose of this study was to compare the risks and benefits of performing open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with compensated cirrhosis. Methods: Data on 50 patients who underwent cholecystectomy for the treatment of symptomatic gallstone dise...

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Published in:Surgery 2000-04, Vol.127 (4), p.405-411
Main Authors: Poggio, Juan Lucas, Rowland, Charles M., Gores, Gregory J., Nagorney, David M., Donohue, John H.
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Rowland, Charles M.
Gores, Gregory J.
Nagorney, David M.
Donohue, John H.
description Background: The purpose of this study was to compare the risks and benefits of performing open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with compensated cirrhosis. Methods: Data on 50 patients who underwent cholecystectomy for the treatment of symptomatic gallstone disease between 1990 and 1997 were collected retrospectively. These patients were divided into 2 groups: Group I included 24 patients who underwent OC, and Group II included 26 patients who underwent LC. The cohorts were well-matched for age, sex, race, clinical presentation, and Child-Turcotte-Pugh (CTP) class. Twelve patients in Group I had a concomitant surgical procedure in contrast to only 2 patients in Group II. No patient in this study had CTP Class C cirrhosis. Results: There was no operative mortality. Conversion to OC was necessary in 3 patients (12%) during LC because of uncontrollable liver bed bleeding in 2 of the patients and insufficient visualization of the anatomy in 1 of the patients. Mean surgical times were significantly longer in Group I when comparing patients from both groups without concomitant surgical procedures (mean ± SD, 177 ± 91.3 minutes vs 116.8 ± 42.3 minutes, P = .037). No patient in Group II required any blood component replacement in contrast to 9 patients (38%) in Group I. Intraoperative bleeding remained significantly higher in Group I when comparing patients without concomitant surgical procedures ( P = .043). No patients in Group II had a wound complication, compared with 2 patients (8%) in Group I. The 12 patients without concomitant surgical procedures in Group I had significantly longer hospital stays when compared with 24 patients without concomitant surgical procedures in Group II (mean ± SD, 6.9 days ± 3.3 [median 6] vs 2.4 days ± 1.8 [median 2.0]); P = .001. Conclusions: Our results demonstrate that laparoscopic cholecystectomy can be performed safely in patients with CTP Class A and B cirrhosis. It offers several advantages over open cholecystectomy, including lower morbidity, shorter operative time, and reduced hospital stay with less need for transfusions. (Surgery 2000;127:405-11.)
doi_str_mv 10.1067/msy.2000.104114
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Methods: Data on 50 patients who underwent cholecystectomy for the treatment of symptomatic gallstone disease between 1990 and 1997 were collected retrospectively. These patients were divided into 2 groups: Group I included 24 patients who underwent OC, and Group II included 26 patients who underwent LC. The cohorts were well-matched for age, sex, race, clinical presentation, and Child-Turcotte-Pugh (CTP) class. Twelve patients in Group I had a concomitant surgical procedure in contrast to only 2 patients in Group II. No patient in this study had CTP Class C cirrhosis. Results: There was no operative mortality. Conversion to OC was necessary in 3 patients (12%) during LC because of uncontrollable liver bed bleeding in 2 of the patients and insufficient visualization of the anatomy in 1 of the patients. Mean surgical times were significantly longer in Group I when comparing patients from both groups without concomitant surgical procedures (mean ± SD, 177 ± 91.3 minutes vs 116.8 ± 42.3 minutes, P = .037). No patient in Group II required any blood component replacement in contrast to 9 patients (38%) in Group I. Intraoperative bleeding remained significantly higher in Group I when comparing patients without concomitant surgical procedures ( P = .043). No patients in Group II had a wound complication, compared with 2 patients (8%) in Group I. The 12 patients without concomitant surgical procedures in Group I had significantly longer hospital stays when compared with 24 patients without concomitant surgical procedures in Group II (mean ± SD, 6.9 days ± 3.3 [median 6] vs 2.4 days ± 1.8 [median 2.0]); P = .001. Conclusions: Our results demonstrate that laparoscopic cholecystectomy can be performed safely in patients with CTP Class A and B cirrhosis. It offers several advantages over open cholecystectomy, including lower morbidity, shorter operative time, and reduced hospital stay with less need for transfusions. (Surgery 2000;127:405-11.)</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1067/msy.2000.104114</identifier><identifier>PMID: 10776431</identifier><identifier>CODEN: SURGAZ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Biological and medical sciences ; Blood Loss, Surgical ; Blood Transfusion ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholelithiasis - classification ; Cholelithiasis - surgery ; Female ; Hemorrhage - epidemiology ; Humans ; Intraoperative Complications - epidemiology ; Length of Stay ; Liver Cirrhosis - complications ; Liver, biliary tract, pancreas, portal circulation, spleen ; Male ; Medical sciences ; Middle Aged ; Minnesota ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Retrospective Studies ; Risk Assessment ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system</subject><ispartof>Surgery, 2000-04, Vol.127 (4), p.405-411</ispartof><rights>2000 Mosby, Inc.</rights><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-7fca590ba710c80406f043c1cf3071634453a50c0945015c2df7d745b3607fcc3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=1339297$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10776431$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Poggio, Juan Lucas</creatorcontrib><creatorcontrib>Rowland, Charles M.</creatorcontrib><creatorcontrib>Gores, Gregory J.</creatorcontrib><creatorcontrib>Nagorney, David M.</creatorcontrib><creatorcontrib>Donohue, John H.</creatorcontrib><title>A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background: The purpose of this study was to compare the risks and benefits of performing open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with compensated cirrhosis. Methods: Data on 50 patients who underwent cholecystectomy for the treatment of symptomatic gallstone disease between 1990 and 1997 were collected retrospectively. These patients were divided into 2 groups: Group I included 24 patients who underwent OC, and Group II included 26 patients who underwent LC. The cohorts were well-matched for age, sex, race, clinical presentation, and Child-Turcotte-Pugh (CTP) class. Twelve patients in Group I had a concomitant surgical procedure in contrast to only 2 patients in Group II. No patient in this study had CTP Class C cirrhosis. Results: There was no operative mortality. Conversion to OC was necessary in 3 patients (12%) during LC because of uncontrollable liver bed bleeding in 2 of the patients and insufficient visualization of the anatomy in 1 of the patients. Mean surgical times were significantly longer in Group I when comparing patients from both groups without concomitant surgical procedures (mean ± SD, 177 ± 91.3 minutes vs 116.8 ± 42.3 minutes, P = .037). No patient in Group II required any blood component replacement in contrast to 9 patients (38%) in Group I. Intraoperative bleeding remained significantly higher in Group I when comparing patients without concomitant surgical procedures ( P = .043). No patients in Group II had a wound complication, compared with 2 patients (8%) in Group I. The 12 patients without concomitant surgical procedures in Group I had significantly longer hospital stays when compared with 24 patients without concomitant surgical procedures in Group II (mean ± SD, 6.9 days ± 3.3 [median 6] vs 2.4 days ± 1.8 [median 2.0]); P = .001. Conclusions: Our results demonstrate that laparoscopic cholecystectomy can be performed safely in patients with CTP Class A and B cirrhosis. It offers several advantages over open cholecystectomy, including lower morbidity, shorter operative time, and reduced hospital stay with less need for transfusions. (Surgery 2000;127:405-11.)</description><subject>Biological and medical sciences</subject><subject>Blood Loss, Surgical</subject><subject>Blood Transfusion</subject><subject>Cholecystectomy</subject><subject>Cholecystectomy, Laparoscopic</subject><subject>Cholelithiasis - classification</subject><subject>Cholelithiasis - surgery</subject><subject>Female</subject><subject>Hemorrhage - epidemiology</subject><subject>Humans</subject><subject>Intraoperative Complications - epidemiology</subject><subject>Length of Stay</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Minnesota</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Surgery (general aspects). 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Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Poggio, Juan Lucas</creatorcontrib><creatorcontrib>Rowland, Charles M.</creatorcontrib><creatorcontrib>Gores, Gregory J.</creatorcontrib><creatorcontrib>Nagorney, David M.</creatorcontrib><creatorcontrib>Donohue, John H.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Poggio, Juan Lucas</au><au>Rowland, Charles M.</au><au>Gores, Gregory J.</au><au>Nagorney, David M.</au><au>Donohue, John H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2000-04-01</date><risdate>2000</risdate><volume>127</volume><issue>4</issue><spage>405</spage><epage>411</epage><pages>405-411</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><coden>SURGAZ</coden><abstract>Background: The purpose of this study was to compare the risks and benefits of performing open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with compensated cirrhosis. Methods: Data on 50 patients who underwent cholecystectomy for the treatment of symptomatic gallstone disease between 1990 and 1997 were collected retrospectively. These patients were divided into 2 groups: Group I included 24 patients who underwent OC, and Group II included 26 patients who underwent LC. The cohorts were well-matched for age, sex, race, clinical presentation, and Child-Turcotte-Pugh (CTP) class. Twelve patients in Group I had a concomitant surgical procedure in contrast to only 2 patients in Group II. No patient in this study had CTP Class C cirrhosis. Results: There was no operative mortality. Conversion to OC was necessary in 3 patients (12%) during LC because of uncontrollable liver bed bleeding in 2 of the patients and insufficient visualization of the anatomy in 1 of the patients. Mean surgical times were significantly longer in Group I when comparing patients from both groups without concomitant surgical procedures (mean ± SD, 177 ± 91.3 minutes vs 116.8 ± 42.3 minutes, P = .037). No patient in Group II required any blood component replacement in contrast to 9 patients (38%) in Group I. Intraoperative bleeding remained significantly higher in Group I when comparing patients without concomitant surgical procedures ( P = .043). No patients in Group II had a wound complication, compared with 2 patients (8%) in Group I. The 12 patients without concomitant surgical procedures in Group I had significantly longer hospital stays when compared with 24 patients without concomitant surgical procedures in Group II (mean ± SD, 6.9 days ± 3.3 [median 6] vs 2.4 days ± 1.8 [median 2.0]); P = .001. Conclusions: Our results demonstrate that laparoscopic cholecystectomy can be performed safely in patients with CTP Class A and B cirrhosis. 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subjects Biological and medical sciences
Blood Loss, Surgical
Blood Transfusion
Cholecystectomy
Cholecystectomy, Laparoscopic
Cholelithiasis - classification
Cholelithiasis - surgery
Female
Hemorrhage - epidemiology
Humans
Intraoperative Complications - epidemiology
Length of Stay
Liver Cirrhosis - complications
Liver, biliary tract, pancreas, portal circulation, spleen
Male
Medical sciences
Middle Aged
Minnesota
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Retrospective Studies
Risk Assessment
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
title A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease
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