Abstract:
Introduction: Concomitant liver cirrhosis is still one the most difficult comorbidities that can increase the rate of unsatisfactory results in
treatment of complicated gallstone disease. Absence of world’s guidelines based on strong evidence, a great amount of complications,
and difficulties during diagnostic process make treatment of complicated gallstone disease in patients with liver cirrhosis one of the
most problematic situations in emergent hepatobiliary surgery.
Material and methods: During this study we analyzed the treatment of 79 patients with liver cirrhosis who had complicated gallstone
disease who were treated in our department. Inclusion criteria for this investigation were complicated gallstone disease acute calculous
cholecystitis, choledocholithiasis and Mirizzi syndrome. Patients condition were assessed using APACHE II system. Stage of cirrhosis
rated with Child-Turcot-Pugh classification and MELD score.
Results: In all cases treatment was started in conservative way. In two patients (Child B) with acute calculous cholecystitis and ascites
during diagnostic laparoscopy was diagnosed spontaneous bacterial peritonitis and treatment was continued in conservative way. In
66 patients (Child A 38, Child B -28) laparoscopic cholecystectomy was performed. In 2 cases were conversions two open procedure
because of intraoperative bleeding and. Among 6 patients with findings of choledocholithiasis in 3 patients ERCP with lithoextraction
and 3open procedures were performed. In 1 cases of Miriizii syndrome laparoscopic cholecystectomy was supplemented with suturing
of cholecysto-common hepatic duct fistula. In 1 case acute cholecystitis was verified only during autopsy (Child C).
Conclusion: Diagnostic process in patients with liver cirrhosis is very difficult because of altered hepatic function.
Description:
National Pirogov Memorial Medical university, Vinnytsya, Department of general surgery, Zhytomyr regional clinical hospital, Department of miniinvasive surgery, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica Moldova