Diagnostics and surgical treatment of the complicated gallstone disease for patients with liver cirrhosis

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.