We performed laparoscopic cholecystectomy for symptomatic cholelithiasis on four patients withcirrhosis of the liver, two of whom had clinical portal hypertension and splenomegaly. Preoperativeexamination disclosed hypersplenism in one patient, while mild thrombocytopenia and decreasedprothrombin concentration were noted in three patients. However, no remarkable bleeding tendencywas recognized clinically in any of the patients. Preoperatively, by Child-Pugh's criteria, three patientshad class B disease and one class A disease. Intraoperatively, remarkable inflammatory changeor fibrotic change of the gallbladder wall and Calot's triangle was observed in two cases, and collateralveins and lymphangial congestion were observed in all four cases. In the first case, extremebleeding and lymphorrhea from dissected sites were observed, and a 1.5 unit of transfusion of wholeblood was required during operation. Postoperatively, increase in ascites which was controlled withdiuretics was recognized in one case. However, the postoperative course was uneventful in all cases,and no serious complications were recognized.
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