Cirrhosis Complications - Surgical Mx

Surgical Management of Complications of Cirrhosis
Dr. Sanjoy Sanyal MBBS, MS
Consultant Surgeon
Victoria Hospital,
Ministry of Health, Seychelles
April 2005

Complications of Cirrhosis – 1 Portal HTN Gastro- oesophageal varices Bleeding Congestive Splenomegaly (Hypersplenism) Ascites

Complications of Cirrhosis – 2 Cirrhosis Fulminant Hepatic failure Hepatic (Porta-systemic) encephalopathy

Untreated

Surgical Anatomy

Surgical Mx – Direct – Control of Bleeding Varices
Ligation of varices
Trans-thoracic
Trans-abdominal

Transection procedures
Gastric
Oesophageal (stapler)
Oesophageal, with oesophago-gastric devascularization (Sugiura)

Resection of varix-bearing area – oesophago-gastrectomy
Roux-en-Y interposition
Jejunal interposition
Colonic interposition
Reversed gastric tube

Surgical Mx – Indirect – Reduction of Portal Pressure / Flow
Porta-caval shunt
End-to-side
Side-to-side
H (jump) graft

Spleno-renal shunt
End-to-end
End-to-side (proximal)
DSRS (selective; Warren)

SMV-IVC shunt (mesenterico-caval)
Side-to-side
H-graft
Coronary-caval (selective; Inokuchi)

Surgical Mx – Intractable Acute Bleeding
Direct – control of bleeding site
Ligation procedure
Transection procedure
Resection procedure
Indirect – reduction of portal pressure
Porta-systemic shunts

Surgical Mx – Miscellaneous
Hypersplenism
Splenectomy
Ascites
Peritoneo-venous shunt
Leveen shunt
Denver shunt
Hepatic failure
Liver transplant

Thank you

Cirrhosis Complications - Surgical Mx

by Sanjoy Sanyal

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