**6.1 Cases**

Cucinotta et al [7] accumulated the records of 22 laparoscopic cholecystectomies which they performed in patients with cirrhosis Child-Pugh A and B. These data were gathered from January 1995 to July 2001. There was no death reported and the average duration of the surgeries were 115 minutes and were noted that they were shorter than the usual open cholecystectomy. They also stated that blood transfusion was not required in all the surgeries and that the intraoperative complications that occurred were liver bed bleeding. They also noted some postoperative morbidities such as hemorrhage, wound complications, cardiopulmonary complications and intraabdominal collections in 36% of the patients but reported that they were all controlled. They observed the length of hospital stay in patients with an average of 4 days. The authors concluded that with laparoscopic cholecystectomy having lower morbidity, shorter operative time and with reduced hospital stay, it can be safely done in patients with cirrhosis Child-Pugh A and B who are carefully selected and screened as to their need for surgery.

Another study was also done by Delis et al [15] from January 1995 to July 2008 where they performed 220 laparoscopic cholecystectomies in patients Child–Pugh class A and B patients with MELD scores ranging from 8 to 27. Their indications for the said operations were symptomatic gallbladder disease and cholecystitis. They reported that no deaths occurred and observed that there were postoperative morbidities that occurred such as hemorrhage, wound complications and intra-abdominal collections but they were controlled. They stated that intraoperative difficulties due to liver bed bleeding were experienced in 19 patients. There was a necessity to convert 12 of their cases to open cholecystectomy. Their median operative time was 95 minutes while their median hospital stay was 4 days. They reported that patients with preoperative MELD scores above 13 showed a tendency for higher complication rates postoperatively. The authors concluded that laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis Child–Pugh A and B and symptomatic cholelithiasis with acceptable morbidity.

graft loss. They concluded that laparoscopic cholecystectomy can be performed safely with

Liver diseases are always considered risk factors in operations due to increase risks of complications and sometimes can even be the cause of death. Liver decompensation is also one reason why clinicians are hesitant to recommend surgeries due to the possible occurrence of abnormal clearance of proteins, abnormal excretion, ascites and portal

There are also factors being considered such as the patients Child-Pugh score, the length and extent of the surgery as well as postoperative complications.[23] The Child-Pugh score is used to evaluate and assess the condition of a patient with liver disease as well as predict mortality during surgery. Nowadays it is also used to establish the prognosis and the

Another recent assessment tool is the Model for End-Stage Liver Disease, or MELD, a scoring system for assessing the severity of chronic liver disease. This system uses the patient's values for serum bilirubin, serum creatinine, and the international normalized ratio

Cucinotta et al [7] accumulated the records of 22 laparoscopic cholecystectomies which they performed in patients with cirrhosis Child-Pugh A and B. These data were gathered from January 1995 to July 2001. There was no death reported and the average duration of the surgeries were 115 minutes and were noted that they were shorter than the usual open cholecystectomy. They also stated that blood transfusion was not required in all the surgeries and that the intraoperative complications that occurred were liver bed bleeding. They also noted some postoperative morbidities such as hemorrhage, wound complications, cardiopulmonary complications and intraabdominal collections in 36% of the patients but reported that they were all controlled. They observed the length of hospital stay in patients with an average of 4 days. The authors concluded that with laparoscopic cholecystectomy having lower morbidity, shorter operative time and with reduced hospital stay, it can be safely done in patients with cirrhosis Child-Pugh A and B who are carefully selected and

Another study was also done by Delis et al [15] from January 1995 to July 2008 where they performed 220 laparoscopic cholecystectomies in patients Child–Pugh class A and B patients with MELD scores ranging from 8 to 27. Their indications for the said operations were symptomatic gallbladder disease and cholecystitis. They reported that no deaths occurred and observed that there were postoperative morbidities that occurred such as hemorrhage, wound complications and intra-abdominal collections but they were controlled. They stated that intraoperative difficulties due to liver bed bleeding were experienced in 19 patients. There was a necessity to convert 12 of their cases to open cholecystectomy. Their median operative time was 95 minutes while their median hospital stay was 4 days. They reported that patients with preoperative MELD scores above 13 showed a tendency for higher complication rates postoperatively. The authors concluded that laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis Child–Pugh A

and B and symptomatic cholelithiasis with acceptable morbidity.

for prothrombin time (INR) to predict the patient's survival after surgery. [11]

low morbidity in renal transplant patients who have symptomatic gallstone disease.

**6. Patients with cirrhotic diseases** 

required treatment for the disease. [23]

screened as to their need for surgery.

hypertension. [11]

**6.1 Cases** 

Leone et al [16] presented their cases between January 1994 and December 2000 where there were 1,100 laparoscopic cholecystectomies for symptomatic gallbladder diseases. They reported that there were 24 cirrhotic patients who had well-compensated cirrhosis (Child's class A or B). The authors reported that there were no operative mortality and the postoperative complication rates were 20.8%. They estimated that the intraoperative blood loss was 37.08 ml in average. Their average hospital stay 3.61 days. The authors concluded that laparoscopic cholecystectomy in patients with compensated cirrhosis is safe and should be the treatment of choice for these patients. They further stated that laparotomy should be applied only if the surgeon considers the operation inadequate to be continued laparoscopically.
