Cholecystectomy in patients with cirrhosis. A surgical challenge
R. S. Bloch, R. D. Allaben and A. J. Walt
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.
