Clinical efficacy and safety of indocyanine green fluorescence cholangiography in laparoscopic cholecystectomy for patients with liver cirrhosis combined with HIV infection

To investigate the clinical application value of indocyanine green fluorescence cholangiography in laparoscopic cholecystectomy (LC) for patients with liver cirrhosis and HIV infection. A retrospective analysis was performed on patients with liver cirrhosis combined with HIV infection who underwent LC at the Department of Hepatobiliary Surgery, Shanghai Public Health Clinical Center, from February 2023 to February 2025. They were divided into an observation group (n = 64) and a control group (n = 62) based on whether indocyanine green fluorescence cholangiography was applied during surgery. Basic data, operation time, time to reach the critical view of safety (CVS), identification of extrahepatic bile ducts, intraoperative blood loss, conversion rate to laparotomy, catheterization rate, postoperative hospital stay, bile duct injury and biliary fistula, and hematological indicators were compared between the two groups. Compared with the control group, the observation group showed significantly shorter operation time, time to reach the critical view of safety (CVS), catheter indwelling time and postoperative hospital stay, as well as significantly less intraoperative blood loss, and lower conversion rate to laparotomy, catheterization rate, incidence of bile duct injury and biliary fistula (all P < 0.05). Before dissecting Calot's triangle, the recognition rates of the cystic duct (65.63% vs. 41.94%) and common hepatic duct (73.44% vs. 45.16%) were higher in the observation group than in the control group (P < 0.05). After dissecting Calot's triangle, the overall recognition rate of extrahepatic bile ducts was significantly improved in the observation group; the recognition rates of the common bile duct (100% vs. 88.71%), common hepatic duct (100% vs. 77.42%), and connection between the cystic duct and common bile duct (85.94% vs. 53.23%) were significantly higher in the observation group than in the control group (P < 0.05). There were no significant differences in white blood cell counts or liver function before and after surgery between the two groups (P > 0.05). Cellular immunity (absolute CD4 + cell count, CD4 + /CD8 + ratio) and humoral immunity indicators showed no significant differences between the two groups (P > 0.05). No incision infections, poor wound healing, abdominal pain, or jaundice occurred in either group postoperatively. No adverse reactions to indocyanine green were observed in the observation group. The use of indocyanine green fluorescence cholangiography during LC in patients with liver cirrhosis and HIV infection enhances the identification of extrahepatic bile ducts, reduces operation time, and significantly decreases the incidence of iatrogenic bile duct injury. This approach is safe and feasible.