Page 10 - Journal of Laparoscopic Surgery

10.5005/jp-journals-10007-1131
REVIEW ARTICLE
Rajiv Gupta
Role and Advantages of Laparoscopic Surgery

in Liver Cirrhosis

Rajiv Gupta
Director, Chief Consultant and Surgeon, Department of General and Laparoscopic Surgery, Rajiv Surgical Clinic and Hospital
Dehradun, Uttarakhand, India

ABSTRACT
Liver cirrhosis has always been associated with operative morbidity and mortality because of associated coagulopathies, nutritional
disorders and portal hypertension. Laparoscopic surgery has changed the thinking and now liver cirrhosis is not a contraindication for
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mild to moderate liver cirrhosis patients. This article’s review studies done by operating laparoscopically on patients with liver cirrhosis
and the methods with which the complications are avoided by laparoscopy during various surgeries and also in the diagnosis and
management of cirrhosis of liver.
Keywords: Laparoscopy, Cirrhosis, Portal hypertension, Laparoscopic surgery in cirrhosis, Cirrhosis and laparoscopy, Surgical
procedures in cirrhosis.

BACKGROUND deformity of the normal liver parenchyma into fibrous nodules
which in turn reduce the liver function to such an extent that
Surgical diseases appear more frequently in patients who
present with cirrhosis. Cholecystitis and cholelithiasis is a the normal functioning of liver is not possible leading to great
5,6
common problem in patients with cirrhosis and open surgery morbidity and finally mortality. The physiological changes
is definitely riddled with dangers due to changes in lead to change in the coagulation profiles, nutritional
homeostasis in the patients which leads to greater morbidity deficiencies, fluid retention, greater susceptibility to infections
and mortality. which in turn increase the peri-and postoperative morbidity
In the past, cirrhosis of liver was considered an absolute due to change in tissue texture and great fluid retention. The
contraindication to laparoscopic surgery. 17 Even the open diagnostic armamentarium is sometimes not able to correctly
surgical procedures were fraught with life-threatening classify the stage of cirrhosis. But the latest articles show that
complications because of associated coagulation disorders, cirrhosis is no longer a contraindication, but in fact is
nutritional deficiencies and sometimes portal hypertension recommended as a safe procedure and provides some
which itself was complicating the outcome of surgery. As the advantages for some surgeries when cirrhosis is associated.
Child–Pugh classification of cirrhosis is still the gold standard
experience of the surgeons grew, even in the laparoscopic 7
surgery, cirrhosis is not considered an absolute contraindication for assessing the severity of the cirrhosis in patients.
2
for laparoscopic procedures, but it is taken with an extra ounce METHODS OF REVIEW
of care. Lots of surgeons have described procedures previously A literature search was performed using the following search
unthought-of laparoscopically but now can be done very safely engines: Hinari, Google, HighWire Press, PubMed and the online
by just taking a few precautions and following the rules of Springerlink MetaPress Library available at the Laparoscopy
good laparoscopic techniques. This article reviews some of the Hospital, New Delhi, India, where this study was carried out.
effects of cirrhosis on the outcomes of minimal access surgery The following terms were used for the search: ‘Laparoscopy in
in recent times. liver cirrhosis’, ‘Liver cirrhosis, diagnosis’, ‘Laparoscopic
Laparoscopic cholecystectomy is definitely a better option surgery in cirrhosis’. ‘Surgery and cirrhosis’ and ‘Surgical
because of the focal vision and to some extent the magnification procedures in cirrhosis’.
offered by the telescope which enable to see the vessels clearly A review of articles has proven that patient number size
and also because of the availability of better instruments for varies from 50 to 1000 in which it is proven that laparoscopic
example harmonic scalpel. The proven benefits of laparoscopy surgery is more useful and less harmful than open surgery
seem to be especially applicable to patients with chronic disease because of the associated disease.
like cirrhosis of liver. 22
AIM
BASICS OF CIRRHOSIS OF LIVER
During this review, the aim was to find out if the laparoscopic
Cirrhosis of liver is a chronic and progressive disease most surgery was dangerous or safe for patients with cirrhosis of
commonly associated with chronic alcoholism which leads to liver. Most of the earlier studies have concluded that open

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