The Value Of MELD Score In Predicting Risks Of Laparoscopic Cholecystectomy In Cirrhotic Patients

BackgroundAs a classical evaluation method of hepatic function and clinical prognosis in cirrhotic patients, Child-Pugh class shows many disadvantages at objectivity of variables and exactness of standard, and no longer suffices the development of hepatology. Respectively, model for end-stage liver disease (MELD) is a continuous evaluation system. Simplicity and objectivity of variables, as long as high specificity makes it an effective method to evaluate the clinical prognosis of patients with compensated or decompensate cirrhosis and hepatic cancer.ObjectiveTo evaluate the safety and feasibility of laparoscopic cholecystectomy in patients with cirrhosis and examines the value of model for end-stage liver disease (MELD) score and Child-Pugh classification in predicting prognosis.MethodsReview the history of 110 laparoscopic cholecystectomies performed in cirrhotic, Child-Pugh class A and B patients in the Second Hospital and Qilu Hospital of Shandong University from January 1998 to October 2010. Indications included symptomatic gallbladder disease, cholecystitis, cystic polypus and cystic adenoma. MELD score and Child-Pugh class were preoperatively calculated and associated with postoperative results. Data regarding patients and surgical outcome were retrospectively analyzed.ResultsNo perioperative deaths occurred. Laparoscopic cholecystectomy was employed in 106 patients, while subtotal cholecystectomy in 4 patients. Median operative time was(77±5.1)min. Median intraoperative blood loss was (51.0±3.33) ml. Mean time to resume diet was (28.0±4.32) hours. Median hospital stay was (5.0±1.3) days. Postoperative complications occurred in 7.27% of the patients, including hemorrhage and intra-abdominal collections, which were all controlled conservatively. The incidence of postoperative complications in Child A patients is 15.47%, with that of Child B 19.23%, MELD score below 147.5%, and above 14 40%. The difference between rates of postoperative complications in patients with preoperative MELD score above 14 and below 14 is significant (P<0.05), with that between Child-Pugh A and B insignificant (P>0.05). The incidence of postoperative complications in patients of MELD<10,10≤MELD<20,MELD>20 is respectively 2.08%,15.91% and 55.56%, indicating a positive correlationship between MELD score and incidence of surgical complications.ConclusionLaparoscopic cholecystectomy is a safe procedure for selected cirrhotic patients with controllable complications, whose MELD scores are initially below 20, and decrease to 14 after preoperative preparation. MELD score appears to predict morbidity more accurately and more precisely than Child-Pugh classification system.