[Extrahepatic digestive surgery in the cirrhotic patient]

Extra-hepatic abdominal surgery is associated with a high degree of risk in cirrhosis patients. Thus mortality is between 8 and 67% and morbidity between 28 and 47%. The chief complications are hepatic insufficiency, sepsis and visceral failure (cardiac, renal and pulmonary). The risk differs according to the organ operated upon, it is less after ordinary cholecystectomy than following gastrectomy or partial colectomy. Herniorrhaphy was a good immediate prognosis. Prognostic factors are above all the presence of ascites, emergency surgery, clotting factors and hypoalbuminemia; mortality is of the order of 10% for child class A but 75% for class C. Improved results thus would require better patient selection and intensive preparation during the peri-operative period with in particular, prophylactic antibiotics in the case of contaminated surgery.