Abstract
To determine whether definitive surgery such as cholecysectomy or extraction of bile duct stones is appropriate in cirrhotic patients the results of definitive surgery have been reviewed retrospectively in a group of 112 cirrhotic patients with cholelithiasis. Eighty-seven of these patients underwent definitive surgery for gallstones and the remaining 25 were treated conservatively. Child's criteria were applied to each patient. Patients with Child's grade A disease had fewer emergency procedures, operative blood loss and transfusion were less and they had a shorter hospital stay compared with patients with grades B and C. There were 4 deaths after definitive surgery for emergency conditions and these were all in Child's grade C. Of the 83 survivors after definitive procedures 78 patients (93.9%) were still alive 52.8 months later without any biliary tract symptoms. Of the 25 patients undergoing conservative treatment 2 were Child's B and 23 were Child's C grade. We suggest that definitive surgery can be carried out safely, in Child's A and B cirrhotic patients, either electively or as an emergency. However, a more conservative approach is advisable in Child C patients with acute conditions and definitive surgery is recommended as an elective procedure after the liver function has improved.