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Table 2 Laparoscopic strategies in advanced liver disease

From: Acute care and emergency general surgery in patients with chronic liver disease: how can we optimize perioperative care? A review of the literature

Port placement

As a general rule, an open Hasson technique is recommended for entry into the peritoneal cavity [31]. To avoid abdominal wall varices from the umbilical vein and falciform ligament, several authors have recommended port placement to the right of the midline, especially the subxiphoid port in laparoscopic cholecystectomy [32, 33].

Pneumoperitoneum

Blunting of the hepatic arterial buffer response is a theoretical risk. There is no report in the literature of liver failure related to pneumoperitoneum in a cirrhotic patient [34, 35]. Some authors reduce their intra-abdominal pressure in cirrhotic patients [36].

Bleeding risk

There are few reports of bleeding during laparoscopic procedures in cirrhotic patients. Cobb et al. describes an 8% transfusion rate, with only one patient requiring transfusion for bleeding [37]. In a retrospective study of 68 patients undergoing laparoscopic cholecystectomy, only one patient received a blood transfusion [35]. Laparoscopic hemostatic devices such as ultrasound knife, ligasure, and harmonic scalpel can significantly improve hemostasis and are recommended by many authors [32, 36].

Conversion

The published conversion rate for laparoscopic cholecystectomy is between 4 and 6%, which is similar to the non-cirrhotic patient population [32, 35,36,37].

Immune function

Li et al. report a reduced risk of bacterial seeding with laparoscopy, with subsequent decreased risk in spontaneous bacterial peritonitis [36].