Feasibility of laparoscopic cholecystectomy for symptomatic gallstone disease with portal cavernoma: Can prior portal vein decompression be avoided?

Bappaditya Har; Siddharth Mishra; Ayyar Srinivas Mahesh; Ankur Shrimal; Rajesh Bhojwani

doi:10.14701/ahbps.23-037

Ann Hepatobiliary Pancreat Surg 2023 Nov;27(4):366-71

Published online November 30, 2023; https://doi.org/10.14701/ahbps.23-037

Bappaditya Har, Siddharth Mishra, Ayyar Srinivas Mahesh, Ankur Shrimal, Rajesh Bhojwani

Department of Surgical Gastroenterology, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital and Medical Research Institute, Jaipur, India

Correspondence to: Rajesh Bhowjani, MS, MCh
Department of Surgical Gastroenterology, Santokba Durlabhji Memorial Hospital and Medical Research Institute, Bhawani Singh Road, Jaipur, Rajasthan 302015, India
Tel: +91-9829176755, Fax: +91-141-47387395, E-mail: docbhojwani@gmail.com
ORCID: https://orcid.org/0000-0001-7887-5286

Received March 20, 2023; Revised May 20, 2023; Accepted May 29, 2023.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract: Backgrounds/Aims: Biliary surgery in patients with extrahepatic portal vein obstruction with portal cavernoma (PC) is technically challenging, and associated with the risk of bleeding. Therefore, prior portal vein decompression is usually recommended before definitive biliary surgery. Only a few studies have so far reported the safety of isolated laparoscopic cholecystectomy. We aimed to evaluate our experience of laparoscopic cholecystectomy in patients with PC without prior portal decompression.
Methods: Prospectively maintained data for patients with PC who underwent laparoscopic cholecystectomy for symptomatic gallstone disease without portal decompression were analyzed. Clinical features, imaging, intraoperative factors, conversion rate, complications of surgery, and long-term outcomes were assessed.
Results: Sixteen patients underwent cholecystectomy without portal decompression from 2012 to 2021, of which interventions 14 were laparoscopic cholecystectomies. One patient required conversion (7.1%) to open surgery. Jaundice was present in 5 patients (35.7%), and underwent endoscopic stone clearance before surgery. Median intraoperative blood loss, operative time, and hospital stay were 100 mL (20−400 mL), 105 min (60−220 min), and 2 days (1−7 days), respectively. Blood transfusion was required in two patients (14.2%). Prior endoscopic or percutaneous intervention was associated with significant blood loss and prolonged intraoperative time.
Conclusions: In centers with experience, prior portal decompression can be avoided in patients with PC requiring isolated cholecystectomy to treat gallstones or their complications. Laparoscopic surgery is safe and feasible for these patients, and gives excellent outcomes in the selected group.; Keywords : Portal cavernoma; Portal cavernoma cholangiopathy; Laparoscopic cholecystectomy; Portal decompression