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Laparoscopic cholecystectomy in patients with portal cavernoma without portal vein decompression
Shridhar Vasantrao Sasturkar1, Nikhil Agrawal1, Asit Arora1, M. P. Senthil Kumar1, Ragini Kilambi1, Shalini Thapar2, Tushar Kanti Chattopadhyay1
1 Department of Hepato-Pancreato- Biliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
2 Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
Correspondence Address:
Nikhil Agrawal,
Max Institute of Cancer Care, Max Superspeciality Hospital, 2, Press Enclave Marg, Saket Institutional Area, Saket, New Delhi - 110 017
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/jmas.JMAS_106_20 PMID: 32964890
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Introduction: Laparoscopic cholecystectomy (LC) in patients with extrahepatic portal vein obstruction causing portal cavernoma (PC) is considered high risk because of portosystemic collateral veins in the hepatocystic triangle. The literature is limited to isolated case reports. We describe our experience of LC in patients with PC.
Patients and Methods: Data of patients with PC who underwent LC for symptomatic gallstones or related complications was reviewed. Patients with simultaneous cholecystectomy with splenorenal shunt and open cholecystectomy were excluded. Pre-operative evaluation consisted of complete blood count, international normalisation ratio and liver function tests, ultrasound of the abdomen with Doppler, contrast-enhanced computerised tomography, magnetic resonance cholangiopancreatography and esophagogastroscopy as indicated. A standard four-port LC was performed. The technical principles followed were to avoid injury to the collateral veins, liberal use of energy sources and division of dominant collateral veins between clips.
Results: Seven adult patients including three females underwent LC. Three patients had thrombosis of previous surgical shunt with persistent PC. The remaining four patients did not have any indication for shunt surgery. Successful LC was performed in six patients. The median duration of surgery was 170 (130–250 min). Blood transfusion was not required. All the patients had uneventful post-operative recovery. The histopathology of gall bladder consists of acute cholecystitis in three patients and chronic cholecystitis in four.
Conclusion: LC is feasible in patients with PC at a centre with experience in both laparoscopic and portal hypertension surgeries. Excellent outcome with low rate of conversion to open surgery can be achieved. |
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