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.

Cannabinoid hyperemesis syndrome (CHS) is a condition observed in patients with chronic use of cannabis. It is characterized with GI symptoms including nausea, vomiting, abdominal pain and diarrhea. The patients tend to be chronic abusers for several years and experience these symptoms in a cyclical manner similar to the cyclical vomiting syndrome. They find relief after taking hot baths, a pathognomonic feature of CHS. We hereby describe 3 cases who presented with clinical features consistent with CHS. Cannabis acts through CB1 and CB2 receptors located in brain and gastrointestinal tract, respectively. There are no standard therapeutic measures available for management of CHS. We propose the idea of using short-acting cannabinoids including dronabinol. Also review of literature suggests treatments with drugs including clonidine, lorazepam and risperidone. Recent endeavors on legalization of recreational cannabis use have initiated several debates and we should be mindful of CHS as one of its long-term complications.