Copyright
©The Author(s) 2016.
World J Gastroenterol. Mar 7, 2016; 22(9): 2725-2735
Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2725
Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2725
Table 1 Causes of liver cirrhosis
Alcoholic liver disease |
Chronic viral hepatitis (hepatitis B and C) |
Non-alcoholic fatty liver disease |
Primary and secondary biliary cirrhosis |
Primary sclerosing cholangitis |
Hemochromatosis |
Autoimmune hepatitis |
Wilson’s disease |
α1-Antitrypsin deficiency |
Celiac disease |
Right-sided heart failure |
Granulomatous liver disease |
Congenital malformation syndromes |
Table 2 Most frequent causes of portal hypertension
Prehepatic etiology of portal hypertension |
Portal vein thrombosis |
External portal vein compression |
Intrahepatic etiology of portal hypertension |
Hepatic cirrhosis (of any origin) |
Congenital hepatic fibrosis |
Schistosomiasis |
Idiopathic non-cirrhotic portal hypertension |
Posthepatic etiology of portal hypertension |
Budd-Chiari’s syndrome |
Sinusoidal obstruction syndrome |
Cirrhose cardiaque |
Score | Groups | Initial function | Mortality assessment | Mortality after liver resection |
ASA | 1-6 | Perioperative risk stratification for any patient | Predictor of 7-d mortality | Not specifically defined |
CPT | A-C | Overall survival in patients with liver cirrhosis | A: 10%, B: 30%, C: 80%; predictor for 30- and 90-d mortality | A: < 9%, no data for B and C |
MELD | 0-40 | Mortality of TIPS-placement | 0-11: 5%-10%, 12%-25: 25%-54%, > 26: 55%-80%; predictor for 30- and 90-d mortality | ≤ 8: 0%; > 8: 29% |
Mayo | Mortality after abdominal, orthopedic and cardiac surgery | 7-, 30-, 90-, 360-, 1800-d mortality | Not specifically defined |
Table 4 Definitions of postoperative liver-failure
Definition | Time of scoring | |
“50-50” | bilirubin > 50 μmol/L, prothrombin time < 50% (INR > 1.7) → mortality of 50% | POD 5 |
ISGLS | Increased INR and hyperbilirubinemia | On or after POD 5 |
ISGLS A | No intervention necessary | |
ISGLS B | Non-invasive intervention necessary | |
ISGLS C | Invasive intervention necessary | |
peakBili > 7 | Maximum hyperbilirubinemia > 7 mg/dL any day after surgery - predictor for 90-d mortality | Any POD |
Shunt | Bypass of portal venous flow | Recurrent haemorrhage/complications |
Porto-caval; end-to-side | Complete | Low rate of recurrent haemorrhage (< 5%) |
Low degree of shunt occlusion | ||
40% encephalopathy | ||
Increase in ascites | ||
Porto-caval, side-to-side +/- interposition graft | Partial | Recurrent haemorrhage 5% |
Low degree of shunt occlusion (5%) | ||
5% encephalopathy | ||
Distal splenorenal shunt (Warren) | Partial | Recurrent haemorrhage 5%-8% |
Shunt occlusion 10% | ||
Selective decompression of gastroesophageal varices |
- Citation: Hackl C, Schlitt HJ, Renner P, Lang SA. Liver surgery in cirrhosis and portal hypertension. World J Gastroenterol 2016; 22(9): 2725-2735
- URL: https://www.wjgnet.com/1007-9327/full/v22/i9/2725.htm
- DOI: https://dx.doi.org/10.3748/wjg.v22.i9.2725