Abstract
Background & Aims: The risk of laparoscopic surgery in cirrhotics remains unclear. We report on outcome and safety of open versus laparoscopic surgery in cirrhotics.
Methods: Retrospective review of cirrhotics undergoing abdominal or pelvic surgery at a university hospital from 2000 to 2010. Pre-, intra-, and post-operative data was collected. Open and laparoscopic patients were compared for post-operative outcomes including minor and major complications, hepatic decompensation, and mortality. Patients were stratified by Child-Pugh and MELD scores, and emergent vs. elective surgery. 164 total patients were identified (131 open and 31 laparoscopic).
Results: There was significantly more intra-operative blood loss (p<0.001) and minor complications (p=0.043) in the open group, but no other significant differences between the laparoscopic and open patients. All 5 deaths occurred in open patients (p=0.58). Increasing Child and MELD scores were predictive of adverse events. Overall complications, hepatic decompensation (p=0.015) and death (p<0.022) were more common in open emergent compared to open elective cases. In open emergent Child C patients, 100% had major complications and hepatic decompensation and 67% died. Of emergent open MELD>20 patients, 100% had major complications, 67% had hepatic decompensation, and 33% died.
Conclusion: Open and laparoscopic surgical approaches for cirrhotics yielded similar safety and outcomes. Child and MELD scores were predictive of adverse outcomes. Emergent cases were more likely to have complications than elective cases. Further studies including larger numbers of emergent laparoscopic patients are needed to better ascertain the risk of laparoscopy in cirrhotics.
Citation
Cohen SM, Dholakia A, VanderHeyden TR, Pillai A and Ahn J. Outcomes and Safety of Open vs. Laparoscopic Surgery in Patients with Cirrhosis. J Gastroenterol. 2015;1(1):1001.