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A Surgical Challenge

Robert S. Bloch, MD; Robert D. Allaben, MD; Alexander J. Walt, MB, ChB

Arch Surg. 1985;120(6):669-672.

Abstract
• 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 failure and sepsis were the usual causes of death. Elective surgical intervention for Child A and B patients with symptomatic cholelithiasis is warranted. In Child C patients, however, every attempt should be made to increase the class to a Child B.

(Arch Surg 1985;120:669-672.

Author Affiliations
From the Department of Surgery, Wayne State University School of Medicine, Detroit.

Footnotes
Accepted for publication Feb 12, 1985.

Read before the 92nd annual meeting of the Western Surgical Association, Colorado Springs, Colo, Nov 12, 1984.

Reprint requests to Department of Surgery, Harper-Grace Hospitals, 3990 John R, Detroit, MI 48201 (Dr Allaben).

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