Copyright
©The Author(s) 2016.
World J Gastroenterol. Mar 7, 2016; 22(9): 2657-2667
Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2657
Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2657
Elements to evaluate | Recommended tests | Recommended action | |
Homeostasis | Thrombo-cytopenia | Platelet number and function by means of thromboelastography | Preoperative transfusion if: |
Platelet > 50000/μL → moderate risk procedures | |||
Platelet > 100000/μL → high risk procedures | |||
Consider desmopressin (300 μg intranasal) if uremia or altered platelet function in thromboelastography | |||
Coagulopathy | PT-INR; thromboelastography. | IV replenishment of vitamin K (≥ 10 mg OD during 3 d) | |
Serum fibrinogen; | Cryoprecipitate if serum fibrinogen ≥ 100 mg/dL | ||
Thromboelastography | |||
Consider Tranexamic acid (10 mg/kg TD during 2-7 d) | |||
Liver function | PTH | Abdominal US | Consider the less invasive surgical treatment or avoid surgery if severe PTH |
Consider TIPS | |||
Ascites | Diagnostic ascitic tap; check diuretics response | Discard SBP | |
Antibiotic prophylaxis or treatment. | |||
Sodium restriction and diuretics (careful monitoring of renal function avoiding hyponatremia) | |||
Large volume of paracentesis for uncontrolled ascites | |||
Esophageal varices | Upper endoscopy; Abdominal US | Consider prophylactic treatment (i.e., β-blockers, variceal banding) based of risk of bleeding | |
Immune function and nutritional status | Malnutrition, hypoalbuminemia | White blood cells count; Nutritional biomarkers: Albumin, Pre-albumin, transferrin; muscle wasting | Optimize protein and caloric intake (higher requirements than normal individuals) |
Vitamin B1 in alcoholics | |||
Administer antibiotic prophylaxis if suspected concurrent infections (Other than SBP) | |||
Glucose intolerance | Laboratory testing | Insulin infusion | |
cardiac function | Cardiomyopathy | Dobutamine stress echocardiography | Consider the less invasive surgical treatment or avoid surgery if severe cardiac dysfunction |
Consider close invasive monitoring and hemodynamic strategy in order to preserve normal cardiac function and avoid organ hypoperfusion (especially liver and kidney) | |||
Consider β-blockers in perioperative period | |||
Renal function | Renal dysfunction; Hepatorenal syndrome | Serum creatinine; Glomerular filtration rate; Evaluate normal Blood Pressure and cardiac performance | Avoid dehydration if possible before surgery |
Avoid positive fluid balance during perioperative course (if hemodynamics allow that) | |||
Pulmonary function | Hydrothorax; HPS; PPH | Chest-X ray; Electrocardiogram and echocardiography; Spirometry | Optimize pulmonary function: |
Discard high arterial pulmonary pressure | |||
Discard pleural effusion/thoracentesis if necessary | |||
If HPS/PPH evaluate appropriate therapy (i.e., IV epoprostenol, sildenafil) | |||
CNS | HE | Clinical assessment; | Use of lactulose despite absence of HE if medical past history or PTH |
Ammonia serum levels | Treat or avoid potential triggers of HE (i.e., diuretics, infections, constipations, CNS depressants, azotemia, uremia, hyponatremia) |
Ref. | Modified technique | Objective and advantage |
Laparoscopic cholecystectomy | ||
Friel et al[77], 1999 | Use of open technique using Hassan’s trocar | Prevent inadvertent puncture of umbilical varix |
Shiff et al[78], 2005 | Placement of the trocar in the right paramedian position | |
Clark et al[79], 2001 | Use of additional ports | Facilitate laparoscopic technique and prevent complications in cases of severe gallbladder inflammation |
Performance of retrograde cholecystectomy | ||
Clark et al[79], 2001 | Modified subtotal cholecystectomy | |
Palanivelu et al[80], 2006 | ||
Friel et al[77], 1999 | Mechanical compression from introduced surgical sponges (i.e., oxidized cellulose) | Facilitate haemostasis |
Application of ultrasonic energy via harmonic scalpel | ||
Use of argon beam coagulator through an operative port | ||
Laparoscopic hernia repair | ||
Belli et al[81], 2006 | Minimally invasive and tension-free laparoscopic technique | Prevent inadvertent puncture of collateral veins |
Prevent recurrence rates and wound infections | ||
McAlister et al[82], 2003 | Dual mesh prosthesis: fixation of mesh in a preperitoneal space | Prevent recurrence rates and mesh migration |
Sterile fashion of mesh insertion | Prevent wound infections |
Type of surgery | Morbidities | Mortality in LC population | Mortality in non-LC population |
Cholecystectomy[77-79,83-86,91-97] | |||
Laparotomy | 30%-35% | 1%-7.7% | 0.5%-1% |
Laparoscopy | 13%-33% | < 1% | < 1% |
Colorectal surgery[10,98] | 43% | 14%-29% (20.9%-35.8% if ES) | 5% |
Radical gastric surgery[99] | 56% (53.3% CTP A, 67.7% CTP B) | - | 80% (5-yr) |
Appendectomy[87,89] | |||
Laparotomy | 5% | 9% | 0.7% |
Laparoscopy | < 1% | < 1% | < 1% |
Pancreatic surgery[100] | 69% (67% CTP A, 100% CTP B) | 9% (3% CTP A, 100% CTP B) | - |
Abdominal wall surgery[81,82,101-110] | |||
Umbilical hernia | 7%-20% | < 1%-5.5% | < 1% |
Inguinal hernia | 6.3%-10.9% | < 1%-2.7% | < 1% |
- Citation: Lopez-Delgado JC, Ballus J, Esteve F, Betancur-Zambrano NL, Corral-Velez V, Mañez R, Betbese AJ, Roncal JA, Javierre C. Outcomes of abdominal surgery in patients with liver cirrhosis. World J Gastroenterol 2016; 22(9): 2657-2667
- URL: https://www.wjgnet.com/1007-9327/full/v22/i9/2657.htm
- DOI: https://dx.doi.org/10.3748/wjg.v22.i9.2657