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Digestive Disease Interventions 2020; 04(02): 168-179
DOI: 10.1055/s-0040-1713370
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Patients with Cirrhosis and Portal Hypertension Requiring Surgery

Dustin Carpenter 
1   Division of Transplantation, Department of Surgery, Center for Liver Disease and Transplantation, New-York Presbyterian/Columbia University Medical Center, New York, New York
,
Peter Liou
2   Division of General Surgery, Department of Surgery, New-York Presbyterian/Columbia University Medical Center, New York, New York
,
Abhishek Mathur
1   Division of Transplantation, Department of Surgery, Center for Liver Disease and Transplantation, New-York Presbyterian/Columbia University Medical Center, New York, New York
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Publikationsverlauf

19. Februar 2020

24. April 2020

Publikationsdatum:
29. Juni 2020 (online)

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Abstract

Cirrhosis significantly increases surgical morbidity and mortality as it causes derangement of multiple organ systems and physiological processes. As such, chronic liver disease and the resultant portal hypertension present distinct perioperative challenges. The risk conveyed by liver disease is dependent on its etiology, the severity of liver dysfunction, the degree to which other organ systems are affected, and the type and timing of surgery to be performed. Careful preoperative planning as well as informed intra- and postoperative decision-making strategies are key factors in ensuring acceptable outcomes in the surgical management of cirrhotic patients. This review will discuss the challenges that cirrhosis with portal hypertension presents to the surgeon, intensivist, and anesthesiologist alike, and identifies key perioperative strategies to mitigate these risks.

Keywords

cirrhosis - portal hypertension - surgery