Laparoscopic cholecystectomy for 58 end stage renal disease patients

Background: Since 1987, laparoscopic cholecystectomy (LC) has been widely used as the favored treatment for gallbladder lesions throughout the world. Because hemorrhage, infection, and delayed wound healing are the main causes of death after surgery for end-stage renal disease (ESRD), laparoscopic surgery is risky for ESRD patients. However, no information has been reported on such patients, so this study aimed to assess the safety of LC in ESRD patients. Method: From January 1994 to December 2003, the medical records of 58 ESRD patients under regular hemodialysis (HD) with gallbladder lesions undergoing LC were reviewed (ESRD-LC). The clinical features and outcomes of 6,182 patients with gallbladder lesions without ESRD undergoing LC were also summarized for comparison. Results: Of 6,240 patients with gallbladder lesions undergoing LC, 58 (0.93%) had ESRD with regular HD. The ESRD-LC group clearly exhibited older age, higher frequency of associated disease, lower hemoglobin and platelet count, and elevated alkaline phosphatase, blood urea nitrogen, and creatinine values. However, only a higher frequency of high American Society of Anesthesiologists (ASA) grade and elevated creatinine value could differentiate ESRD-LC and LC patients by multivariate analysis. Similar blood loss, conversion rate, morbidity, mortality, and hospital stay were noted for the two groups. Conclusions: LC is safe for ESRD patients with gallbladder lesions. Only a higher frequency of high ASA grade and elevated creatinine value could differentiate ESRD-LC and LC patients. Similar blood loss, conversion rate, morbidity, mortality, and hospital stay were achieved by applying LC to treat ESRD patients. However, appropriate preoperative preparations and experienced operative techniques are still required to prevent mortality.