Surgical Approach in Cirrhotic Patients

Author(s): Jacques Belghiti, Safi Dokmak and Vikram Raut

Pp: 66-79 (14)

* (Excluding Mailing and Handling)

Abstract

• The number of patients with cirrhosis requiring liver surgery is increasing, with hepatocellular carcinoma being the major indication. The mortality rate of cirrhotic patients is –two to three times higher than that of non-cirrhotic patients.

• Preoperative assessment and risk stratification are challenging. Attention should be paid to liver function, portal hypertension, and systemic conditions including nutritional status.

• Low central venous pressure, anterior approach, and vascular occlusion are useful strategies to reduce bleeding during hepatectomies on cirrhotic patients. Also, laparoscopic resections can minimize some postoperative complications, mainly ascites.

• Fresh frozen plasma and/or albumin, as well as diuretics, are useful in the management of postoperative ascites, which occurs in more than a third of patients.Postoperative liver failure is associated with very high mortality and should be early recognized for proper management.

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