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June 1985

Cholecystectomy in Patients With CirrhosisA Surgical Challenge

Author Affiliations

From the Department of Surgery, Wayne State University School of Medicine, Detroit.

Arch Surg. 1985;120(6):669-672. doi:10.1001/archsurg.1985.01390300019003

• 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.

(Arch Surg 1985;120:669-672.