ABSTRACT:
Background: Open surgery has got poor results over the years in cirrhotic patients. In the past, the laparoscopic surgery was also a contraindication in these patients. The associated coagulopathy, portal hypertension & nutritional disorders were considered to be the risk factors for increased morbidity & mortality. However, with increasing experience, innovations, equipments & expertise in the field of laparoscopy, the role of laparoscopy for the diagnosis of cirrhosis as well as the treatment of various surgical conditions among cirrhotic patients is increased with good results.
Objective: To evaluate the role of laparoscopy in the diagnosis of liver cirrhosis with emphasis on the increasing use of laparoscopy in the diagnosis & treatment of specific & non specific surgical conditions in cirrhotic patients.
Place & Duration: This study was conducted at Ghulam Muhammad Mahar Medical College Hospital & Hira Medical Centre Sukkur, from Jan 2008 to Dec 2010
Study design: A prospective descriptive study
Patients & Methods:
This study included 143 cirrhotic patients. The patients of child-Pugh classification A & B (Compensated Cirrhosis) were included, while child’s-C (Compensated Cirrhosis) were excluded from the study. Diagnostic laparoscopy & liver biopsy were done in 23 patients, while Laparoscopic Cholecystectomy (L.C) was done in 120 patients with symptomatic cholelithiasis & cholecystitis. Pre-operative preparation of patients was done by correcting coagulopathy, control of portal hypertension, fluid & electrolyte balance. Laparoscopic Subtotal Cholecystectomy (LSC) was done in cases of severe inflammation, leaving the posterior wall of the gall bladder with the liver bed. Hemostasis was secured by topical agents (like surgicel or sponge stone), application of ultrasonic energy via harmonic scalpel and the use of argon beam coagulator on the liver bed.
Results: The mean age of patients was 45 years and the male to female ratio was 1:3. The mean operating time in the diagnostic laparoscopy & liver biopsy was 20 minuets, while in the laparoscopic choleacystecty group was 50 minutes. Average hospital stay was 02 days. Diagnostic laparoscopy & liver biopsy were done in 23 (16.8%) patients, standard laparoscopic cholecystctomy in 83 (58.4%) patients & modified subtotal L.C in 37 (25.87%) patients. Liver biopsy caused mild bleeding in 09 (6.29%) patients. Post-operative morbidity in L.C group found in 37.06% of patients and in 10% of patients post-operative deterioration of liver function occurred. Mortality was 0.699%.
Conclusion: Laparoscopy is safe & more accurate in the diagnosis of liver cirrhosis & getting liver biopsy. L.C is also a safe & effective treatment in selected cirrhotic patients with symptomatic cholelithiasis & cholecystitis.
Key words: Laparoscopy, cholecystectomy, cirrhosis
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