Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis.
TLDR
It is concluded that celiotomy in the cirrhotic patient is truly associated with very high morbidity and mortality, and preoperative assessment can predict survival with 89% accuracy.Abstract:
Celiotomy in cirrhotic patients is reported to bear a high risk of operative morbidity and mortality. We reviewed 100 consecutive, cirrhotic patients who underwent nonshunt celiotomy. Thirty patients died and major complications occurred in another 30 patients. Hospital mortality rate was 21% in 39 biliary operations, 35% in 26 procedures for peptic ulcer disease, and 55% in nine colectomies . Fifty-two variables were compared between survivors without complication, survivors with complications, and nonsurvivors. A computer-generated, multivariant discriminant analysis yielded an equation predictive of survival. Utilizing coagulation parameters, presence of active infection, and serum albumin, the equation predicted survival with 89% accuracy. In a similar fashion, amount of operative transfusions, absence of postoperative ascites, pulmonary failure, gastrointestinal bleeding, and culture-positive urine predicted survival with 100% accuracy. We conclude that celiotomy in the cirrhotic patient is truly associated with very high morbidity and mortality, and preoperative assessment can predict survival with 89% accuracy.read more
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Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document
Antoni Rimola,Guadalupe Garcia-Tsao,Miquel Navasa,Laura J. V. Piddock,Ramon Planas,B Bernard,John M. Inadomi +6 more
TL;DR: This article represents the final consensus document and is divided into three separate sections concerning the diagnosis, treatment and prophylaxis of SBI?
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One thousand fifty-six hepatectomies without mortality in 8 years.
Hiroshi Imamura,Yasuji Seyama,Norihiro Kokudo,Atsushi Maema,Yasuhiko Sugawara,Keiji Sano,Tadatoshi Takayama,Masatoshi Makuuchi +7 more
TL;DR: Liver resection can be performed without mortality provided that it is carried out in a high-volume medical center by well-trained hepatobiliary surgeons paying meticulous attention to the balance between the liver functional reserve and the volume of liver to be removed.
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ESPEN Guidelines on Enteral Nutrition: Liver disease ☆
Mathias Plauth,Eduard Cabré,Oliviero Riggio,M. Assis-Camilo,Matthias Pirlich,Jens Kondrup,P. Ferenci,E. Holm,S. vom Dahl,Manfred J. Müller,W. Nolte +10 more
TL;DR: EN by means of ONS is recommended for patients with chronic LD in whom undernutrition is very common and TF commenced early after liver transplantation can reduce complication rate and cost and is preferable to parenteral nutrition.
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EASL Clinical Practice Guidelines on nutrition in chronic liver disease
Manuela Merli,Annalisa Berzigotti,Shira Zelber-Sagi,Srinivasan Dasarathy,Sara Montagnese,Laurence Genton,Mathias Plauth,Albert Parés +7 more
TL;DR: These Clinical Practice Guidelines review the present knowledge in the field of nutrition in chronic liver disease and promote further research on this topic, with recommendations provided in specific settings such as hepatic encephalopathy, cirrhotic patients with bone disease, patients undergoing liver surgery or transplantation and critically ill cirrhosis patients.
References
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Transection of the oesophagus for bleeding oesophageal varices
TL;DR: Emergency ligation of bleeding oesophageal varices using the Milnes Walker technique was performed in 38 patients, and in patients with good preoperative liver function this rose to 71% and the simple scoring system for grading the severity of disturbance of liver function was found to be of value in predicting the outcome of surgery.
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Cholecystectomy in cirrhotic patients: A formidable operation
TL;DR: Cholecystectomy and common bile duct exploration in cirrhotic patients should be performed only for life-threatening complications of biliary tract disease such as empyema, perforation and ascending cholangitis.
Journal Article
Biliary tract surgery and cirrhosis: a critical combination.
TL;DR: A more conservative approach toward elective cholecystectomy in the cirrhotic patient is indicated and increased bleeding should be anticipated; extensive intrahepatic dissection should be avoided.
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Morbidity and mortality after operation in nonbleeding cirrhotic patients.
TL;DR: In cirrhotic patients a clear need for operation must exist, liver function must be optimized preoperatively, and the most simple and expeditious procedure must be performed to avoid excessive blood loss and postoperative complications.