Laparoscopic Cholecystectomy for the Liver Cirrhosis Patient with Transjugular Intrahepatic Portosystemic Shunt -Report of A Case-

Atsushi Iida, Makoto Ishida, Kanji Katayama and Akio Yamaguchi

First Department of Surgery, Fuculty of Medicine, University of Fukui

In laparoscopic surgery on patients with liver cirrhosis, intraperitoneal pressure adversely affects the portal blood flow. The transjugular intrahepatic portosystemic shunt (TIPS) effectively relieves portal hypertension. Encephalopathy by hyperammonemia or portal hypertension, however depends on shunt flow. We report a case of laparoscopic cholecystectomy used for liver cirrhosis in a patient with cholecystolithiasis using TIPS. A 42-year-old man with liver cirrhosis admitted recurrent cholecystolithiasis was treated using TIPS for his portal hypertension and duodenal varicosity 8 years earlier. Laboratory data showed the followings: Hb 11.7 g/dl, PLT 73,000/μl, PT 12.8 sec, AST 25 IU/l, ALT 23 IU/l, ZTT 16.9 U, TTT 10.8 U, ammonia 88 μg/dl and ICG 15 min 44%. Gasless laparoscopic cholecystectomy was done safely without adversely affecting portal blood flow. Despite serum ammonia of 112 μg/dl peaking on postoperative day (POS) 3, he was discharged on POD 7. The patient has been well in the 3 years since surgery. This is, the first report to our knowledge, of laparoscopic cholecystectomy treated using TIPS. The gasless procedure and/or a porto-systemic shunt appears useful in treating patients with liver cirrhosis.

Key words
TIPS, liver cirrhosis, laparoscopic cholecystectomy

Reprint requests
Atsushi Iida First Department of Surgery, Faculty of Medicine, University of Fukui
23-3 Shimoaizuki, Matsuoka, Yoshida-gun, Fukui, 910-1193 JAPAN

Accepted
February 25, 2004

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