Laparoscopic Versus Open Cholecystectomy in Cirrhotic Patients
Abdel-Raouf Abdallah Abdel-Raouf Abdou;
Abstract
Cirrhosis is a gradually developing, chronic disease of the liver which always involves the organ as a whole.
In most cases, no clear dividing line can be drawn between cirrhosis and the preceding liver disease.
Definitive classification of cirrhosis is difficult. It can be categorized according to its etiology, morphology, pathogenetic development, clinical features and prognostic criteria.
Cirrhosis of the liver is a disease found all over the world, affecting all races, age groups and both sexes.
The causes of “liver cirrhosis” are numerous; some of them are rare, appearing even in childhood (e.g. drinking water from copper pipes). Cirrhosis can be acquired or genetically based.
Cirrhosis clinically can be differentiated into Latent cirrhosis or Manifest cirrhosis:
Various forms manifest as hypersplenism, increasing collateral varicosis with a simultaneous rise in the splanchnic flow due to hyperdynamic circulation and vasodilatation in the area of the splanchnic vessels, hepatic encephalopathy, and edema and ascites.
Cirrhosis can be diagnosed either by clinical symptoms (easy fatigability, GIT disturbance, etc), clinical signs as icterus, abdominal mass (hepato-splenomegaly) or laboratory (liver function tests) or radiological (abdominal ultrasonography and CT) invetigations and finally liver biopsy.
The prognosis for cirrhotic patients depends upon the respective complications. The underlying morphological processes, such as necrosis, fibrosis and regeneration, combine to widely differing degrees in the single cirrhotic patient.
Complications such as variceal bleeding, hepatic encephalopathy, ascites, infections and reduced renal function also influence the mortality rate of liver cirrhosis. The main causes of death are hepatic coma or liver failure, bleeding, infections and HCC. Spontaneous bacterial peritonitis is fatal in 50-70.
Gall bladder stone disease is a wide range of diseases affecting the gall bladder, several types of methods are applied for a confident diagnosis. These are explained below.
Cholecystectomy is a commonly performed surgical procedure for patients suffering from symptomatic gallstones. Open cholecystectomy (OC) was the method of choice for gallbladder surgery for almost a century and now the laparoscopic cholecystectomy is considered as first option for cholelithiasis.
About 70-80% of cholecystectomies are done laparoscopically whereas 20-30% are still completed by open cholecystectomy in compromised patients and patients with complicated gallstones. Howeve LC can safely be performed in cirrhotic patients and in cases of acute cholecystitis by experienced surgeon.
Most studies focused on the comparison of LC and OC and emphasized the better outcome of LC. At present, it is well understood that patients undergoing LC have a better and shorter recovery time compared to those undergoing OC.
In most cases, no clear dividing line can be drawn between cirrhosis and the preceding liver disease.
Definitive classification of cirrhosis is difficult. It can be categorized according to its etiology, morphology, pathogenetic development, clinical features and prognostic criteria.
Cirrhosis of the liver is a disease found all over the world, affecting all races, age groups and both sexes.
The causes of “liver cirrhosis” are numerous; some of them are rare, appearing even in childhood (e.g. drinking water from copper pipes). Cirrhosis can be acquired or genetically based.
Cirrhosis clinically can be differentiated into Latent cirrhosis or Manifest cirrhosis:
Various forms manifest as hypersplenism, increasing collateral varicosis with a simultaneous rise in the splanchnic flow due to hyperdynamic circulation and vasodilatation in the area of the splanchnic vessels, hepatic encephalopathy, and edema and ascites.
Cirrhosis can be diagnosed either by clinical symptoms (easy fatigability, GIT disturbance, etc), clinical signs as icterus, abdominal mass (hepato-splenomegaly) or laboratory (liver function tests) or radiological (abdominal ultrasonography and CT) invetigations and finally liver biopsy.
The prognosis for cirrhotic patients depends upon the respective complications. The underlying morphological processes, such as necrosis, fibrosis and regeneration, combine to widely differing degrees in the single cirrhotic patient.
Complications such as variceal bleeding, hepatic encephalopathy, ascites, infections and reduced renal function also influence the mortality rate of liver cirrhosis. The main causes of death are hepatic coma or liver failure, bleeding, infections and HCC. Spontaneous bacterial peritonitis is fatal in 50-70.
Gall bladder stone disease is a wide range of diseases affecting the gall bladder, several types of methods are applied for a confident diagnosis. These are explained below.
Cholecystectomy is a commonly performed surgical procedure for patients suffering from symptomatic gallstones. Open cholecystectomy (OC) was the method of choice for gallbladder surgery for almost a century and now the laparoscopic cholecystectomy is considered as first option for cholelithiasis.
About 70-80% of cholecystectomies are done laparoscopically whereas 20-30% are still completed by open cholecystectomy in compromised patients and patients with complicated gallstones. Howeve LC can safely be performed in cirrhotic patients and in cases of acute cholecystitis by experienced surgeon.
Most studies focused on the comparison of LC and OC and emphasized the better outcome of LC. At present, it is well understood that patients undergoing LC have a better and shorter recovery time compared to those undergoing OC.
Other data
| Title | Laparoscopic Versus Open Cholecystectomy in Cirrhotic Patients | Other Titles | مقارنة الاستئصال المنظارى والإستئصال الجراحى التقليدى للحوصلة المرارية فى حالات التليف الكبدى | Authors | Abdel-Raouf Abdallah Abdel-Raouf Abdou | Issue Date | 2014 |
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