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Magyar CTJ, Gaviria F, Li Z, Choi WJ, Ma AT, Berzigotti A, Sapisochin G. Surgical Considerations in Portal Hypertension. Clin Liver Dis 2024; 28:555-576. [PMID: 38945643 DOI: 10.1016/j.cld.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
This review provides an in-depth exploration of portal hypertension (PH) and its implications in various surgical procedures. The prevalence of clinically significant PH is 50% to 60% in compensated cirrhosis and 100% in decompensated cirrhosis. The feasibility and safety of hepatic and nonhepatic surgical procedures in patients with PH has been shown. Adequate preoperative risk assessment and optimization of PH are integral parts of patient assessment. The occurrence of adverse outcomes after surgery has decreased over time in this specific population, due to the development of techniques and improved perioperative multidisciplinary care.
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Affiliation(s)
- Christian Tibor Josef Magyar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; University Health Network, HPB Surgical Oncology, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Felipe Gaviria
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; University Health Network, HPB Surgical Oncology, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Zhihao Li
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; University Health Network, HPB Surgical Oncology, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Woo Jin Choi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; University Health Network, HPB Surgical Oncology, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Ann Thu Ma
- Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Gonzalo Sapisochin
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; University Health Network, HPB Surgical Oncology, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University Health Network, Toronto, Canada.
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Ding M, Yin Y, Wang X, Zhu M, Xu S, Wang L, Yi F, Abby Philips C, Gomes Romeiro F, Qi X. Associations of gallbladder and gallstone parameters with clinical outcomes in patients with cirrhosis. J Transl Int Med 2024; 12:308-316. [PMID: 39081278 PMCID: PMC11285020 DOI: 10.2478/jtim-2022-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Background Morphologic changes in the gallbladder and gallstones are common in cirrhotic patients, but their associations with outcomes of cirrhotic patients are unclear. Methods We retrospectively enrolled 206 cirrhotic patients and measured their gallbladder length and width, gallbladder wall thickness, presence of gallstones, and gallstones' length and width in axial contrast-enhanced computed tomography (CT) images. X-tile software was utilized to calculate the optimal cutoff values of these parameters for evaluating survival and hepatic decompensation events in the cirrhosis group. Their associations with survival were explored by Cox regression analyses and Kaplan-Meier curve analyses. Their associations with hepatic decompensation events were evaluated by competing risk analyses and Nelson-Aalen cumulative risk curve analyses where death was a competing event. Results Cirrhotic patients with gallbladder length < 72 mm had a significantly higher cumulative survival rate than those with a length of ≥ 72 mm (P = 0.049 by log-rank test), but gallbladder width, gallbladder wall thickness, presence of gallstones, and gallstones' length and width were not significantly associated with survival (P = 0.10, P = 0.14, P = 0.97, P = 0.73, and P = 0.73 by log-rank tests, respectively). Cirrhotic patients with gallbladder wall thickness < 3.4 mm had a significantly lower cumulative rate of hepatic decompensation events than those with a wall thickness of ≥ 3.4 mm (P = 0.02 by Gray's test), but gallbladder length and width, presence of gallstones, and gallstones' length and width were not significantly associated with hepatic decompensation events (P = 0.15, P = 0.15, P = 0.54, P = 0.76, and P = 0.54 by Gray's tests, respectively). Conclusion Changes in gallbladder length and gallbladder wall thickness, rather than gallstone parameters, may be in parallel with the long-term outcomes of cirrhotic patients.
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Affiliation(s)
- Min Ding
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110840, Liaoning Province, China
| | - Yue Yin
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110840, Liaoning Province, China
| | - Xueying Wang
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Menghua Zhu
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
| | - Shixue Xu
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110840, Liaoning Province, China
| | - Le Wang
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110840, Liaoning Province, China
| | - Fangfang Yi
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
| | - Cyriac Abby Philips
- Clinical and Translational Hepatology & Monarch Liver Laboratory, the Liver Institute Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Kochi682028, India
| | - Fernando Gomes Romeiro
- Gastroenterology Division, Department of Internal Medicine, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu18608917, Brazil
| | - Xingshun Qi
- Liver Cirrhosis Study Group, Department of Gastroenterology, the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, Liaoning Province, China
- Postgraduate College, China Medical University, Shenyang 110840, Liaoning Province, China
- Postgraduate College, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China
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Hanna K, Zangbar B, Kirsch J, Bronstein M, Okumura K, Gogna S, Shnaydman I, Prabhakaran K, Con J. Non-operative management of cirrhotic patients with acute calculous cholecystitis: How effective is it? Am J Surg 2023; 226:668-674. [PMID: 37482476 DOI: 10.1016/j.amjsurg.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Nonoperative management (NOM) of acute calculous cholecystitis (ACC) in patients with cirrhosis was proposed. We examined the outcomes of cirrhotic patients with ACC treated with cholecystectomy compared to NOM. METHODS We analyzed the 2017-Nationwide Readmissions Database including cirrhotic patients with ACC. Patients were stratified: cholecystectomy, percutaneous cholecystostomy (PCT), and antibiotics only. PRIMARY OUTCOMES complications, failure of NOM. SECONDARY OUTCOMES mortality, length of stay (LOS), and charges. RESULTS 3454 patients were identified. 1832 underwent cholecystectomy, 360 PCT, and 1262 were treated with antibiotics. PCT patients had higher mortality 16.9% vs. the antibiotics group 10.9% vs. cholecystectomy group 4.2%. PCT patients had longer LOS, but lower charges compared to the operative group. Failure of NOM was 28.2%. On regression, PCT was associated with mortality. CONCLUSION ACC remains a morbid disease in cirrhosis patients. One in three failed NOM, had longer LOS, and higher mortality. Further studies are warranted to identify predictors of NOM failure. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
- Kamil Hanna
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Bardiya Zangbar
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Jordan Kirsch
- Department of Surgery, Westchester Medical Center, New York, USA.
| | | | - Kenji Okumura
- Department of Surgery, Westchester Medical Center, New York, USA.
| | - Shekhar Gogna
- Department of Surgery, Medstar Health, Washington, USA.
| | - Ilya Shnaydman
- Department of Surgery, Westchester Medical Center, New York, USA.
| | | | - Jorge Con
- Department of Surgery, Westchester Medical Center, New York, USA.
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Abstract
Diseases of the gallbladder include a spectrum of gallstone diseases (cholelithiasis, cholecystitis, choledocholithiasis, and cholangitis), cysts, polyps, and malignancy. In this review, we present the incidence, risk factors, clinical presentation, diagnosis, and treatment of these various conditions. Importantly, we report when more urgent referral is indicated, as well as red flags that warrant further intervention and/or management.
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Affiliation(s)
- Seth Anthony Politano
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA.
| | - Nida Hamiduzzaman
- Division of GHPGIM, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Dalal Alhaqqan
- Division of Gastroenterology and Hepatology, MedStar Georgetown University Hospital, Washington, DC, USA
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Ding L, Wang S, Jiang W, Miao Y, Liu W, Yang F, Zhang J, Chi W, Liu T, Liu Y, Wang S, Zhang Y, Zhao H. Identification of Intestinal Microbial Community in Gallstone Patients with Metagenomic Next-Generation Sequencing. Diagnostics (Basel) 2023; 13:2712. [PMID: 37627971 PMCID: PMC10453932 DOI: 10.3390/diagnostics13162712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Gallstone disease (GD) is one of the most common gastrointestinal diseases worldwide. Nowadays, intestinal microbiota are thought to play important roles in the formation of gallstones. In our study, human fecal samples were extracted for metagenomic next-generation sequencing (mNGS) on the Illumina HiSeq platform, followed by bioinformatics analyses. Our results showed that there was a particular intestinal micro-ecosystem in GD patients. In contrast to healthy people, the sequences of Bacteroidetes, Bacteroides and Thetaiotaomicron were obviously more abundant in GD patients at phylum, genus and species levels, respectively. On the other hand, the glycan metabolism and drug resistance, especially for the β-lactams, were the most profound functions of gut microbes in GD patients compared to those in normal subjects. Furthermore, a correlation analysis drew out that there existed a significant relationship between the serum levels of biochemical indicators and abundances of intestinal microbes in GD patients. Our results illuminate both the composition and functions of intestinal microbiota in GD patients. All in all, our study can broaden the insight into the potential mechanism of how gut microbes affect the progression of gallstones to some extent, which may provide potential targets for the prevention, diagnosis or treatment of GD.
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Affiliation(s)
- Li Ding
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
| | - Su Wang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
| | - Wenrong Jiang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
| | - Yingxin Miao
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
| | - Wenjian Liu
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
| | - Feng Yang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
| | - Jinghao Zhang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
| | - Wenjing Chi
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
| | - Tao Liu
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yue Liu
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
| | - Shiwen Wang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
| | - Yanmei Zhang
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
| | - Hu Zhao
- Department of Laboratory Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Research Center on Aging and Medicine, Fudan University, Shanghai 200040, China
- Department of Laboratory Medicine, Huadong Hospital, Shanghai 200040, China
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Sarici KB, Akbulut S, Karabulut E, Sahin TT, Kucukakcali Z, Garzali IU, Aloun A, Yilmaz S. Histopathological Features of Gallbladder Specimens Obtained From Liver Recipients. Transplant Proc 2023:S0041-1345(22)00869-7. [PMID: 36604252 DOI: 10.1016/j.transproceed.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND To evaluate the histopathological features of gallbladder specimens obtained from liver transplantation (LT) recipients and to find the correlation between these findings with the clinical features of patients. METHODS The 1985 patients who underwent LT in our institute between March 2002 and January 2021 and whose data regarding pathologic analysis of gallbladder could retrospectively be obtained were included in the study. The data of the patients including age, gender, the reason for LT (fulminant or nonfulminant), presence of ascites, macroscopic characteristics of gallbladder (the length, diameter, and wall thickness), and microscopic findings were all obtained and analyzed in the present study. RESULTS A total of 1985 patients (men = 1300 and women = 685) with a median age of 39.4 years were included in this study. LT was performed in 249 patients because of fulminant liver failure, and abdominal ascites were detected in 933 patients during LT. There were statistical differences in terms of age (P < .001), gallbladder length (P < .001). and width (P < .001) among the both gender, but there was no difference in terms of histopathologic characteristics and presence of gallstones. On the other hand, there were significant differences in terms of age (P < .001), gallbladder length (P < .001), width (P < .001), wall thickness (P = .021), presence of gallstones (P < .001), and histopathologic characteristics (P < .001) between the patients with fulminant and nonfulminant liver failure etiologies. Similar results were obtained when characteristics of patients with and without ascites were compared. CONCLUSIONS This the first study analyzing the histopathological analysis of gallbladder specimens in LT recipients. Chronic liver disease, presence of ascites and gender are the factors affecting the macroscopic and microscopic features of the gallbladder.
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Affiliation(s)
- Kemal Baris Sarici
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey; Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Ertuğrul Karabulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Tevfik Tolga Sahin
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Zeynep Kucukakcali
- Department Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ibrahim Umar Garzali
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey; Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ali Aloun
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Minimally invasive treatment of cirrhotic secondary hypersplenism with high-intensity focused ultrasound. Sci Rep 2022; 12:20700. [PMID: 36450808 PMCID: PMC9712649 DOI: 10.1038/s41598-022-24416-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
High-intensity focused ultrasound (HIFU) has been reported to be a minimally invasive effective method for the treatment of secondary hypersplenism. However, neither the short-term efficacy nor the indications and/or contraindications have been described in patients with cirrhosis. From October 2019 to May 2021, eleven cases of patients with cirrhotic secondary hypersplenism were enrolled. The blood counts, liver function tests and abdominal ultrasound and/or MRI scans of all patients were closely evaluated. Among these 11 patients, eight (72.7%) patients were classified as Child-Pugh A, and the other 3 (27.3%) patients were Child-Pugh B; Five (45%) patients were diagnosed with gallstone, including multiple small stones in 2 patients and single stone in 3 patients. HIFU was performed successfully in all 11 patients. After HIFU, hematologic parameters and liver function were significantly improved in all 11 patients (p < 0.05). The HIFU ablated volume to spleen volume rate was 35-61%. Complications were ecchymosis of the waist in 7 (63.3%) patients, ablated area pain in 3 (27.3%) patients, and choledocholithiasis in 2 (18.2%) patients with multiple small gallstones. All of them recovered smoothly without additional treatment except for 2 patients with choledocholithiasis recovered with risky endoscopic retrograde cholangiopancreatography (ERCP) treatment. This series suggested that HIFU is an effective and safe treatment for cirrhotic secondary hypersplenism in patients classified as Child-Pugh A or B. However, multiple small gallstones could be a relative contraindication for it.
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Jadaun SS, Saigal S. Surgical Risk Assessment in Patients with Chronic Liver Diseases. J Clin Exp Hepatol 2022; 12:1175-1183. [PMID: 35814505 PMCID: PMC9257927 DOI: 10.1016/j.jceh.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023] Open
Abstract
Chronic liver diseases (CLD) is one of the leading causes of morbidity and mortality. The overall life span of patients with CLD has increased and so is the number of surgical procedures these patients undergo. Pathophysiological and hemodynamic changes in cirrhosis make these patients more susceptible to hypotension and hypoxia during surgery. They also have a high risk of drug induced liver injury, renal dysfunction and post-operative liver decompensation. Patients with CLD planned for elective or semi-elective surgery should undergo detailed preoperative risk assessment. Patients should be evaluated for the presence of clinically significant portal hypertension and cirrhosis. In the absence of both cirrhosis and clinically significant portal hypertension, patients with CLD can undergo surgery with minimal or low risk. Various risk assessment tools available for patients with advanced CLD are-CTP score, MELD Score, Mayo risk score, VOCAL-Penn score. A Child class C and/or Mayo risk score >15 in general is associated with high risk of post-operative mortality and elective surgery should be deferred in these patients. In patients with Child class, A and MELD 10-15 surgery is permissible with caution (except liver resection and cardiac surgery) while in Child A and MELD <10 surgery is well tolerated. VOCAL-Penn score is a new promising tool and can be the better alternative of CTP, MELD, and Mayo risk score models but more prospective studies with large patients' population are warranted. Certain surgeries like Hepatic resection, intraabdominal, and cardiothoracic have higher risk than abdominal wall hernia repair and orthopedic surgery. Laparoscopic approaches have better outcomes and less risk of liver failure than open surgery. Minimally invasive alternatives like colonic stent placement in case of obstruction can be considered in high-risk cases. Perioperative optimization and management of ascites, HE, bleeding, liver decompensation, and nutrition should be done with multidisciplinary approach. Patients with cirrhosis undergoing high risk elective surgery can develop liver failure in post-operative period and should be evaluated and counseled for liver transplantation if not contraindicated.
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Key Words
- ASA, American Society of Anaesthesiologists
- CLD, Chronic liver disease
- CTP, Child-Turcotte-Pugh
- Cirrhosis
- HCC, Hepatocellular carcinoma
- HVPG, hepatic venous pressure gradient
- MELD, Model for end stage liver disease
- NASH, Non-alcoholic steatohepatitis
- ROTEM, rotational thromboelastometry
- Surgery in cirrhosis
- Surgical risk assessment
- TEG, Thromboelastography
- VOCAL-Penn score, Veterans Outcomes and Costs Associated with Liver Disease-Penn score
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Affiliation(s)
| | - Sanjiv Saigal
- Address for correspondence. Sanjiv Saigal MD DM MRCP CCST, Principal Director and Head, Hepatology and Liver Transplant Medicine Centre for Liver and Biliary Sciences CLBS Max Super Speciality Hospital, Saket New Delhi, 110017, India.
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