Gallbladder And Biliary Tract Surgery

Gallbladder And Biliary Tract Surgery

Biliary tract surgery, including cholecystectomy, presents a particular problem in patients with cirrhosis, in part because of the increased vascularity of the gallbladder bed in patients with cirrhotic portal hypertension and the massive bleeding that may result from dissection of the gallbladder, even in the absence of overt coagulopathy. Coagulopathy and portal hypertension are relative contraindications to laparoscopic cholecystectomy. An open cholecystectomy in patients with cirrhosis carries a mortality rate of up to 25%. In an emergency, cholecystostomy, rather than cholecystectomy, is recommended in patients with poorly compensated cirrhosis and portal hypertension.