Liver Cirrhosis and Biliary Surgery

Abstract

Operations on the biliary tract in cirrhotic patients are reported to have a higher than normal risk of operative morbidity and mortality; 39 cases from 2 university-based hospitals were observed over a 5-yr period. Each patient had biliary tract surgery and biopsy-proven cirrhosis; 8 patients died (21%) and major complications were found in 12 surviving patients (35%). Local and systemic sepsis was the major contributor, accounting for all of the deaths and 17 of the 22 (77%) complications among survivors. Choledochotomy was done in 10 patients; 3 of them died (30%) and 9 major complications occurred in the remaining 5. Preoperative risk factors found to be predictive of this high morbidity and mortality were ascites (50% mortality, 50% morbidity), prolonged prothrombin time (29% mortality, 38% morbidity) and a serum albumin level of < 3.5 mg/dl (33% mortality, 40% morbidity). The presence of other major systemic disease was not significantly different between survivors and nonsurvivors. In 12 patients with no ascites and normal preoperative serum chemistry values, no deaths and only 1 minor complication occurred. Although biliary surgery in cirrhotic patients carries a high mortality, this risk can be assessed preoperatively. There appears to be a small subgroup of patients with cirrhosis and cholelithiasis who can have a favorable outcome. Operative therapy in these patients should be reserved for the complications of the biliary tract.