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J Visc Surg. 2014 Jun;151(3):203-11. doi: 10.1016/j.jviscsurg.2014.04.004. Epub 2014 May 5.

Non-hepatic gastrointestinal surgery in patients with cirrhosis.

Author information

1
Department of digestive and oncological surgery, hôpital Nord, place Victor-Pauchet, 80054 Amiens cedex 01, France.
2
Department of digestive and oncological surgery, hôpital Nord, place Victor-Pauchet, 80054 Amiens cedex 01, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.

Abstract

Gastrointestinal surgery is feasible in patients with Child A cirrhosis, but is associated with higher morbidity and mortality. Hernia repair, biliary and colonic surgery are the most frequently performed interventions in this context. Esophageal and pancreatic surgery are more controversial and less frequently performed. For patients with decompensated liver function (Child B or C patients), the indications for surgery should be discussed by a multi-specialty team including the hepatologist, anesthesiologist, surgeon; liver function should be optimized if possible. During emergency surgery, histologic diagnosis of cirrhosis should be confirmed by liver biopsy because the histologic diagnosis has therapeutic and prognostic implications. The management of patients with Child A cirrhosis without portal hypertension is little different from the management of patients without cirrhosis. However, the management of patients with Child B or C cirrhosis or with portal hypertension is more complex and requires an accurate assessment of the balance of benefit vs. risk for surgical intervention on a case-by-case basis.

KEYWORDS:

Cirrhosis; Digestive surgery; Morbidity and mortality; Post-operative ascites

PMID:
24810712
DOI:
10.1016/j.jviscsurg.2014.04.004
[Indexed for MEDLINE]

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