Outcome of biliary tract surgery in unknown cirrhotics: a case-control study.

Saeed Hamid43
Estimated H-index: 43
(Aga Khan University Hospital),
M Siddiqui1
Estimated H-index: 1
+ 3 AuthorsMohammad Nadeem Ahmed3
Estimated H-index: 3
Sources
Abstract
Abstract The substantial risk of biliary surgery in patients with liver cirrhosis may be reduced by preoperative preparation but the problem of the unknown cirrhotic remains. We studied 18 patients found incidentally to have cirrhosis at surgery. The perioperative complications and the outcome in these patients was compared with 18 non-cirrhotic patients, computer matched for age and sex, undergoing the same operations. Mean blood loss at operation was 324 ml (SD 218.1 ml) in the cirrhotic group and 105 ml (SD 74.7 ml) in the control group (P < 0.01). The postoperative complication rate was 38% in cirrhotics, but zero in controls (P < 0.01). The length of hospital stay was significantly increased in the cirrhotic group (P < 0.01). There was no mortality in either group. The incidental finding of cirrhosis at biliary surgery is associated with increased peroperative bleeding and increased morbidity. There is no increase in mortality in such patients.
📖 Papers frequently viewed together
236 Citations
3 Citations
References12
Newest
#1H V Steinberg (Emory University)H-Index: 7
#2William W. Beckett (Emory University)H-Index: 1
Last. Michael E. Bernardino (Emory University)H-Index: 32
view all 6 authors...
One hundred and two patients with cirrhosis and portal hypertension were evaluated sonographically to determine the presence or absence of cholelithiasis. The gallbladder was visualized in 80 of 102 patients. Cholelithiasis was present in 43 of 80 cases (54%). All 22 patients in whom the gallbladder was not seen sonographically had had a previous cholecystectomy. Five of them were operated on prior to development of cirrhosis with portal hypertension, but 14 of the remaining 17 (82%) had evidenc...
19 CitationsSource
#1Mark S. Hickman (University of Texas Health Science Center at San Antonio)H-Index: 3
Last. Carey P. Page (University of Texas Health Science Center at San Antonio)H-Index: 24
view all 3 authors...
• The influence of diabetes on the risks associated with the operative treatment of acute cholecystitis has not been clearly defined. Therefore, a case-control study of 72 diabetics requiring urgent operation for acute cholecystitis was undertaken. Patients were matched for age, gender, and date of surgery with nondiabetic controls. Review of patient records revealed no significant difference in hospital stay or severity of operative and pathologic findings. However, diabetics suffered significa...
47 CitationsSource
#1Gerard V. AranhaH-Index: 41
#2Daniel M. KrussH-Index: 3
Last. Herbert B. GreenleeH-Index: 28
view all 3 authors...
Summary Between 1979 and 1984, 21 male cirrhotic patientswith advanced liver disease, cholecystitis, and jaundice were seen. Eight patients had persistent symptoms of acute cholecystitis despite intense medical management. Of these patients, five underwent cholecystostomy and survived. The other three patients had cholecystectomy and one died. Thirteen patients presented with jaundice. Twelve patients underwent endoscopic retrograde cholangiography which revealed gallbladder stones in four but n...
25 CitationsSource
#1Kenneth R. SirinekH-Index: 18
#2Raymond R. Burk (University of Texas Health Science Center at San Antonio)H-Index: 1
Last. Barry A. Levine (University of Texas Health Science Center at San Antonio)H-Index: 25
view all 4 authors...
• Fifty-one patients with cirrhosis underwent 65 major abdominal procedures, with an 8% mortality and a 28% complication rate. Preoperative and perioperative management was comparable to that rendered patients with cirrhosis undergoing portosystemic shunting procedures. Emergency operation, persistent coagulation defects (prothrombin time and partial thromboplastin time prolonged 2 s), blood loss greater than 4 U, and exploration of the common bile duct were factors associated with increased mor...
48 CitationsSource
#1G DunningtonH-Index: 1
#2E Alfrey (UA: University of Arizona)H-Index: 1
Last. C PutnamH-Index: 1
view all 5 authors...
To assess the natural history of cholelithiasis in patients with cirrhosis, 32 charts coded for both diseases were retrospectively reviewed. Cholecystectomy was performed in 22 patients. Only two patients met criteria for acute cholecystitis and two patients had suspected choledocholithiasis. Despite the high incidence of preoperative jaundice (32%), no common duct stones were documented. There was no operative mortality. The complication rate was 45%. In 10 patients not operated upon, two patie...
23 CitationsSource
#1Kathleen KogutH-Index: 1
#2Terrence AragoniH-Index: 1
Last. Norman B. AckermanH-Index: 7
view all 3 authors...
• A conservative approach toward elective cholecystectomy in the patient with cirrhosis has been suggested because of the strong likelihood of excessive bleeding, sepsis, and multiple organ failure. We reviewed this problem in two medical centers, studying 27 patients with cirrhosis who had undergone nonemergency biliary tract surgery. Most patients had adequate liver function preoperatively. Most operations were cholecystectomies without duct exploration. Among factors analyzed were liver funct...
30 CitationsSource
#1Robert S. BlochH-Index: 1
#2Robert D. AllabenH-Index: 4
Last. Alexander J. WaltH-Index: 25
view all 3 authors...
• Cholecystectomy or cholecystostomy was performed in 49 patients with cirrhosis with a mortality of 10.2%. Massive intraoperative blood loss was found in 16.3% and major wound problems (dehiscence, abscess) in 12.2%. Intraoperative blood loss, amount of blood transfused, and mortality were correlated with the Child classification of hepatic reserve. Mortality was 23.5% for Child C patients vs 0% for Child A patients. Excessive blood loss from a hypervascular biliary bed and resulting liver fail...
107 CitationsSource
#1Denis CastaingH-Index: 92
#2Didier HoussinH-Index: 45
Last. Henri BismuthH-Index: 89
view all 4 authors...
Abstract Among the cirrhotic patients admitted to our department, 64 (17 percent) were found to have cholelithiasis. In 14 patients (22 percent), cholelithiasis caused cholecystitis, obstructive jaundice, or biliary pain. These 14 patients were operated on and underwent cholecystectomy. There was one postoperative complication (gastrointestinal bleeding from esophageal varices) and one death (due to acute respiratory failure). In 50 patients (78 percent) cholelithiasis was asymptomatic. Ten of t...
53 CitationsSource
#1Gerard V. AranhaH-Index: 41
#2Stephen J. SontagH-Index: 36
Last. Herbert B. GreenleeH-Index: 28
view all 3 authors...
Abstract Cholecystectomy and common bile duct exploration in cirrhotic patients is associated with an 83 percent mortality if prothrombin time is prolonged 2.5 seconds over control. The causes of death are related to complications of liver disease such as hepatic encephalopathy, ascites, sepsis and hemorrhage. If the prothrombin time is prolonged, major intraoperative blood loss can be anticipated, and blood and plasma transfusion requirements may be massive. Jaundice in the presence of cirrhosi...
236 CitationsSource
: Gallbladder and extrahepatic bile duct operations merit special consideration in cirrhotic patients. During the past 15 years at Strong Memorial Hospital, 33 cirrhotic patients have undergone cholecystectomy or an operation for bile duct obstruction. Of the 21 patients with cirrhosis subjected to cholecystectomy for cholecystitis and cholelithiasis, nine had uncomplicated courses. Included in this group was one patient in whom the intrahepatic portion of the gallbladder was deliberately not re...
136 Citations
Cited By8
Newest
#1Jerome M. Laurence (USYD: University of Sydney)H-Index: 18
#2Peter Duy Tran (Liverpool Hospital)H-Index: 3
Last. Vincent Lam (USYD: University of Sydney)H-Index: 25
view all 5 authors...
Background Cholecystectomy is associated with increased risks in patients with cirrhosis. The well-established advantages of laparoscopic surgery may be offset by the increased risk for complications relating particularly to portal hypertension and coagulopathy.
54 CitationsSource
#1Abdul Razaque Shaikh (Liaquat University of Medical and Health Sciences)H-Index: 3
#2Ambreen MuneerH-Index: 3
Background and Objectives: Gallstones are twice as common in cirrhotic patients as in the general population. Although laparoscopic cholecystectomy (LC) has become the gold standard for sumptomativ gallstones, cirrhosis has been considered an absolute or relative contraindication. Many authors have reported on the safety of LC in cirrhotic patients. We reviewed our patients retrospectively and assessed the safety of LC in cirrotic patients at a tertiary care hospital in Pakistan.Methods: From Ja...
21 CitationsSource
Background In this study we retrospectively evaluated a group of symptomatic cirrhotic (n = 30) and non-cirrhotic (n = 60) patients submitted to laparoscopic cholecystectomy (LC) in a public hospital in Brazil.
17 CitationsSource
BACKGROUND: Initially considered a contraindication to the surgical laparoscopy, cirrhosis have been an occasional discovery during this procedure. Until now many series reported in the literature suggest that the majority of the surgeons still consider cirrhosis as contraindication to the laparoscopic cholecystectomy. AIM: To evaluate our experience in laparoscopic treatment of the cholelithiasis in cirrhotic patient. PACIENTS AND METHODS: Six hundred and four patients with symptomatic cholelit...
4 CitationsSource
#1Lavonne UrbanH-Index: 2
#2Gregory A EasonH-Index: 1
Last. Trudi BrownH-Index: 1
view all 8 authors...
Abstract Purpose Traditionally, cholecystectomy in cirrhotic patients has been reserved for patients with severe biliary disease, because of the high morbidity and mortality in cirrhotic patients undergoing this procedure. Laparoscopic cholecytectomy (LC) was originally contraindicated in cirrhotic patients because of the associated portal hypertension and coagulopathy. This study examined the safety of LC in Child’s class A patients. Methods A review was conducted of all patients with cirrhosis...
20 CitationsSource
Considerando que sao duas doencas frequentes na populacao, a associacao entre cirrose hepatica e colelitiase tambem e um achado comum. E importante o conhecimento desta situacao porque a evolucao clinica da cirrose pode ser complicada pela presenca de colelitiase e, ao contrario, uma colelitiase sintomatica pode ser de dificil tratamento nos pacientes cirroticos. Os autores fazem uma revisao da literatura enfocando os aspectos clinicos e terapeuticos desta associacao.
1 CitationsSource
ABSTRACT Surgical literature around 1980 has emphasized the technical challenge and the risks of cholecystectomy in cirrhotic patients reporting discouraging results. The aim of this study is the retrospective analysis of laparoscopic cholecystectomy in cirrhotics. The collected laparoscopic experience of 3 surgical groups for the last 5 years is reported. Cirrhotics were classified according to Child-Pugh criteria. Postoperative complications were classified using Clavien's rules. Forty patient...
37 CitationsSource
#1Mushtaq AhmedH-Index: 5
#2Turab PishoriH-Index: 3
At the Aga Khan University Medical Center (AKUMC) in Karachi, which is a nongovernmental, private, fee-for-service institution, cholecystectomies constituted 20% (222/1133) of the general surgical procedures in 1995 and ranked first in frequency. By comparison, in one general surgical unit of a government hospital, the Civil Hospital, Karachi, which caters for an indigent population, the frequency of cholecystectomies was 9% (67/753) during that year [1]. It appears that gallstone disease is com...
1 CitationsSource