Cholecystectomy in Cirrhotic Patients: Pitfalls and Reasonable Recommendations

Abstract

Cholecystectomy in cirrhotic patients remains a high risk procedure. The recent literature was reviewed in the objective to elaborate (evidence-based) recommendations for therapeutic decision. In patients with Child Pugh A or B cirrhosis, the laparoscopic approach should be preferred as it is associated with reduced morbidity and mortality as compared with open surgery (level B). In patients with decompensated Child Pugh C cirrhosis, the scarcity of literature data renders much more hazardous the definition of robust recommendations. In these patients, two options have to be considered beyond early laparoscopic cholecystectomy: first, a delayed surgery, in order to improve the preoperative patient’s general condition and namely the coagulation, and second, a percutaneous drainage in very severe cases (level C).

Key Words:

• Cholecystectomy
• Cirrhosis
• Laparoscopy
• guidelines.

Additional information

Notes on contributors

V. Donckier

V. Donckier, M.D. Department of Abdominal Surgery Hôpital Erasme, Université Libre de Bruxelles 808, route de Lennik 1070 Brussels Tel.: [phone] Fax: [phone] E-mail: [email protected]