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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2016; 22(9): 2657-2667
Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2657
Outcomes of abdominal surgery in patients with liver cirrhosis
Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Antoni J Betbese, Joan A Roncal, Casimiro Javierre
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
Juan C Lopez-Delgado, Francisco Esteve, Rafael Mañez, IDIBELL (Institut d’Investigació Biomèdica Bellvitge, Biomedical Investigation Institute of Bellvitge), Research Team of Area of Innate Immunity and Pathology of the Critical Patient, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
Antoni J Betbese, Joan A Roncal, Hospital de la Santa Creu i Sant Pau, Intensive Care Department, 08041 Barcelona, Spain
Casimiro Javierre, Physiological Sciences II Department, Universitat de Barcelona, Campus Bellvitge, 08907 Barcelona, Spain
Author contributions: Lopez-Delgado JC, Ballus J, Esteve F and Mañez R wrote the paper and performed the research; Betbese AJ, Roncal JA and Javierre C wrote part of the paper and reviewed it for final remarks; all authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Juan C Lopez-Delgado, MD, PhD, Hospital Universitari de Bellvitge, Intensive Care Department, C/Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, 08907 Barcelona, Spain. juancarloslopezde@hotmail.com
Telephone: +34-650506985 Fax: +34-932607963
Received: June 15, 2015
Peer-review started: June 19, 2015
First decision: September 9, 2015
Revised: October 30, 2015
Accepted: December 14, 2015
Article in press: December 14, 2015
Published online: March 7, 2016
Processing time: 260 Days and 15.7 Hours
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.

Keywords: Liver cirrhosis; Outcomes; Coagulopathy; Nutritional status; Abdominal surgery; Adaptive immune dysfunction; Cirrhotic cardiomyopathy

Core tip: The prevalence of chronic liver disease is increasing. Patients with liver cirrhosis may be more likely to need non-hepatic abdominal surgery than the non-cirrhotic population. The rising incidence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis may increase the prevalence of cirrhotic patients within the abdominal surgery population. The pathophysiological characteristics of the condition raise the surgical risk and the likelihood of poor prognosis. A review of the assessment and outcomes for non-hepatic abdominal procedures in these patients is essential since most current recommendations are based on observational studies.