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]. |