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      Outcomes of abdominal surgery in patients with liver cirrhosis.

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          Abstract

          Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes. Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery. In the emergency setting, with the presence of decompensated LC, alcoholic hepatitis, severe/advanced LC, and significant extrahepatic organ dysfunction conservative management is preferred. A multidisciplinary, individualized, and specialized approach can improve outcomes; preoperative optimization after risk stratification and careful management are mandatory before surgery. Laparoscopic techniques can also improve outcomes. We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before, during, and after surgery.

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          Author and article information

          Journal
          World J. Gastroenterol.
          World journal of gastroenterology
          Baishideng Publishing Group Inc.
          2219-2840
          1007-9327
          Mar 07 2016
          : 22
          : 9
          Affiliations
          [1 ] Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Hospital Universitari de Bellvitge, Intensive Care Department, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
          Article
          10.3748/wjg.v22.i9.2657
          4777990
          26973406

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