To value the impact of laparoscopic versus open surgery in cirrhotic patients undergoing a cholecystectomy (with
Patients & Methods:
We have evaluated all patients with cirrhosis who underwent a cholecystectomy in the period 2002-2012: 51
patients, 28 males, 23 females; mean age 63 years (range 43-91 yr); child-pugh class A 80%, class B 20%: 13 patients (25.49%) underwent
a open cholecystectomy (OC) whereas 38 patients (74.50%) underwent a laparoscopic cholecystectomy (LC) with 12 patients (31.5%)
converted from LC to OC. Most patients (90%) had the diagnosis of cirrhosis previously defined.
The mean operative time was 82 min in LC and 168 min in OC, the mean hospital stay 7 days in LC and 17 days in OC;
conversion rate was 31.5%. No mortality in our series. The total morbidity in OC was 32% (8/25) vs 15% (4/26) in LC: transient ascites
OC 16% (4/25) vs. LC 7.6% (2/26), wound hematomas OC 8% (2/25) vs. LC 3.8% (1/26); in 2 patients treated with open access and in
one converted to OC we have had blood transfusion requirement. The evaluation of post-operative deterioration of liver function tests
(LFTs) (OC 28% vs. LC 36%) is very difficult because of the changes caused by pneumoperitoneum or also by open procedure.
Cirrhotic patients with symptomatic cholelithiasis have increased hospital stay, operative time and
postoperative morbidity with open cholecystectomy versus laparoscopic approach; therefore minimally invasive surgery should be the
preferred initial choice in cirrhotic patients with cholelithiasis.
Vincenzo Neri was born in Bari, Italy, on 15
March, 1946. He graduated in 1970 in Medicine and Surgery from the University of Bari. He is a fulltime
Professor of General Surgery in the Medical School of the University of Foggia, Polyclinic. He is Director of the Residency School of General Surgery
and Department of General Surgery. He was President of the Course of Degree of Medicine and Surgery, University of Foggia, in the years from
1996 to 2002. He was Director of Department of Surgical Sciences, University of Foggia in the years from 2002 to 2008. He obtained the certificate of
?Maitrise Universitaire en Pedagogie des Sciences de la Sant? from the Universit? Paris ? Nord Bobigny. He is the author of more than 330 scientific
paper edited on national and international journals and chapters of books. His research interest is hepatobiliopancreatic surgery. He is a member of
scientific societies : SIC, IHPBA, AISP, EASL, NESA and SLS.
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