الفهرس 
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Abstract
SUMMARY
This study was carried out in Surgery Dep. Benha University Hospital and include 50 patients with symptomatic cholelithiasis, who were scheduled for laparoscopic cholecystectomy in whom hepatitis C infection was diagnosed pre-operatively in 25 patients.Their ages ranged between (25-75) years with a mean 50. The sex distribution in HCV positive patients was 20 males and 5 females and in HCV negative patients was 10 males and 15 females. All patients were of class A and B according to Child’s classification, excluding those with obstructive jaundice. They were assessed clinically including full history, general examination and local examination. All patients were subjected to laboratory investigations including CBC, FBG, PPBG, liver function tests, renal function tests and HCV examination (antibodies and PCR). Also they were examined by real-time ultrasonography in an attempt to assess the liver, gall bladder, CBD, portal vein, spleen ascitis, other abdominal masses and aortic lymph nodes , ECG and plain chest X-ray.
The associated diseases with HCV positive patients were 2 diabetic patients, one hypertensive patient, one COPD patient and 3 obese patients. The associated diseases with HCV negative patients were one diabetic patient, one hypertensive patient and one obese patient.
During operation the perforation of gall bladder had occurred in 10 patients, 6 patients of them are HCV positive and another 4 patients of HCV negative. Spillage of bile and stones had occurred in 6 patients, mild bleeding in 2 patients, one patient of them with HCV positive, one patients are converted to open surgery with HCV positive. Then the patients were nursed in the Fowler position and received suitable antibiotics, analgesics and intravenous fluids. All patients were mobilized out of bed the night of surgery and discharged one to two days after the procedure, all returned back 3 days later for first visit. The second visit was 10 days after discharge in which stitches were removed.
Fifty to 70 minutes with the mean was 60 minutes is a time of operation for HCV -ve and 70-90 minutes with the mean was 80 minutes is a time of operation for HCV +ve. 12 patients are drained by intra-peritoneal drain. 8 patients of them are HCV positive. One to three days of median two days for post-operative hospitalization. And 3, 10 days, one week, 2 weeks and one month postoperative follow up. The complications are bleeding in two patients, one patient of them with HCV positive, mild biloma in 2 patients one of them with HCV positive, chest infection in 2 patients one of them with HCV positive, wound infection in 10 patients. 6 of them with HCV positive and liver histology in cohort of 25 patients with HCV positive are 9 patients of quiescent or minimal changes, 3 patients of mild chronic hepatitis, 2 patients of moderate chronic hepatitis, 2 patients of sever chronic hepatitis, 5 patients of cirrhosis, one patient of steatosis, one patient of cholestasis and 2 patients of inadequate or not performed pathology.
CONCLUSION
We conclude from this study that:
• Patient with hepatitis C with symptomatic gall stone have a chance of getting red of their symptoms through laparoscopic cholecystectomy if done with certain precautions with acceptable complication rate.
• Preoperative vitamin K liver support (glucose 10%), and tranexamic acid 48 hours before surgery improves the results.
• Premedications Hyosine amp., Fentanyle amp. i.v. If needed and oxygen
• The induction of general anaesthesia and its maintain all should be through drugs safe on the liver e.g. Propofol i.v., a Tracurium amp., Endotrachial intubation and isoflurane.
• Pay attention for all drugs even antibiotics for these patient.
• It is advised to give H2 receptor blocker and beta-blocker together with continuing Vit. K injection in the immediate postoperative for at least 48 hours to avoid postoperative stress bleeding.
• Good haemostasis in the gall bladder bed is essential.
• A drain should be left behind if the dissection was extensive and if the haemostasis was not convenient i.e. some mild ooze from the gall bladder bed this to be removed in 24 to 48 hours.
• Taking all these precousions make the results of laparoscopic cholecystectomy in hepatitis C patients (child A and B) nearly equal to those without hepatitis C virus infection.