LAPAROSCOPIC VERSUS OPEN CHOLECYSTECTOMY IN CIRRHOTIC PATIENTS: A PROSPECTIVE RANDOMIZED STUDY

Aim: Improved laparoscopic experience and techniques have made laparoscopic cholecystectomy (LC) feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy (OC) versus LC in compensated cirrhosis. Method: A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group (55 patients) and LC group (55 patients). Results: There was no operative mortality. In LC group 4(7.33%) patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group (96.13 + 17.35m vs. 76.13+ 15.12) P 0.05,associated with significantly higher intraoperative bleeding in OC group (P 0.01),necessitatating blood transfusions to 7 (12.72%) patients in OC group. The time to resume diet was 18.36+8.18h in LC group which significantly earlier than in OC group 47.84+14.6 h P 0.005.Hospital stay was significantly longer in OC group than LC group (6+1.74 days vs. 1.87+1.11 days) P 0.01 with low postoperative morbidity. Conclusion: LC in cirrhotic is still complicated and highly difficult which associates with significant morbidity compared with that of patients without cirrhosis. However, It offers lower morbidity, shorter operative time; early resume dieting with less need for blood transfusion and reducing hospital stay than OC.