Biliary tract surgery and XXXX : a critical combination.

@entity1 @entity2835 @entity82 @entity295 @entity548 @entity2963 @entity2679 @entity954 @entity3488
Gallbladder and extrahepatic bile duct operations merit special consideration in cirrhotic @entity1 . During the past 15 years at Strong Memorial Hospital, 33 cirrhotic @entity1 have undergone cholecystectomy or an operation for bile duct obstruction. Of the 21 @entity1 with @entity82 subjected to cholecystectomy for @entity2679 and @entity2963 , nine had uncomplicated courses. Included in this group was one @entity1 in whom the intrahepatic portion of the gallbladder was deliberately not resected. The other 12 @entity1 (57%) had @entity954 and required transfusion of three or more units of blood. One @entity1 required additional exploratory surgery and antifibrinolytic therapy to control @entity548 . In an additional group, only one of seven @entity1 whose gallbladder was removed during a portal decompressive procedure bled excessively from the liver bed. A third group of five @entity1 , including four with @entity2835 who underwent operations on the bile duct for obstruction, had massive @entity954 (greater than 5 U). Four of the five exsanguinated, and the remaining @entity1 died of @entity295 . A more conservative approach toward elective cholecystectomy in the cirrhotic @entity1 is indicated. If an operation is performed, increased @entity548 should be anticipated; extensive intrahepatic dissection should be avoided. Intraoperative infusion of @entity3488 and an antifibrinolytic agent should be considered.
