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Risks of intra-abdominal nonshunt surgery in cirrhotics
N Gopalswamy1, V Mehta, C J Barde
1GI Division, Wright State University, and VA Medical Center, Dayton, Ohio, USA.
Insights
Cirrhotic patients with Child
Area of Science:
- Hepatology and Surgical Gastroenterology
- Clinical Risk Assessment in Cirrhosis
Background:
- Intra-abdominal operations in patients with cirrhosis carry significant risks.
- Existing risk stratification methods have limitations for surgical decision-making.
Purpose of the Study:
- To review the risks associated with nonshunt intra-abdominal operations in cirrhotic patients.
- To evaluate the utility of the Child-Pugh classification in predicting surgical outcomes.
Main Methods:
- Review of retrospective studies on nonshunt intra-abdominal operations in cirrhotic patients.
- Analysis of risk stratification using the Child-Pugh classification (Child's A, B, C).
Main Results:
- Elective surgery is generally safe for Child's A and B patients.
- Operations in Child's C patients and emergent surgeries have high mortality rates.
- Strategies like limiting surgical extent, managing ascites, and treating infections may reduce mortality.
Conclusions:
- Child-Pugh classification is informative for assessing surgical risk in cirrhosis.
- Minimally invasive procedures like laparoscopic cholecystectomy and endoscopic sphincterotomy show promise.
- Careful patient selection and management are crucial for improving outcomes in cirrhotic patients undergoing surgery.
Abstract:
We have reviewed the risks of various nonshunt intra-abdominal operations in cirrhotic patients. Most of these studies are retrospective reviews with limitations. Among various risk stratifications in cirrhosis, Child-Pugh classification is sufficiently informative. Elective surgery can be done safely in patients with Child's A or B class. Operations in Child's C patients and emergent surgery carry formidably high mortality. Limiting the extent of surgery, controlling ascites, correcting coagulation abnormality and malnutrition and aggressively treating infection, might reduce mortality. Laparoscopic cholecystectomy and endoscopic sphincterotomy in cirrhotics seem to be promising in reducing mortality and morbidity.