Surgical Management of Complications of   Cirrhosis <ul><li>Dr. Sanjoy Sanyal MBBS, MS </li></ul><ul><li>Consultant Surgeo...
Complications of Cirrhosis – 1 Portal HTN Gastro- oesophageal  varices Bleeding Congestive Splenomegaly (Hypersplenism) As...
Complications of Cirrhosis – 2   Cirrhosis Fulminant Hepatic failure Hepatic (Porta-systemic) encephalopathy
Untreated
Surgical Anatomy
Surgical Mx – Direct – Control of Bleeding Varices <ul><li>Ligation  of varices </li></ul><ul><ul><li>Trans-thoracic </li>...
Surgical Mx – Direct – Control of Bleeding Varices <ul><li>Transection procedures </li></ul><ul><ul><li>Gastric </li></ul>...
Surgical Mx – Direct – Control of Bleeding Varices <ul><li>Resection of varix-bearing area – oesophago-gastrectomy </li></...
Surgical Mx – Indirect – Reduction of Portal Pressure / Flow <ul><li>Porta-caval shunt </li></ul><ul><ul><li>End-to-side <...
<ul><li>Spleno-renal shunt </li></ul><ul><ul><li>End-to-end </li></ul></ul><ul><ul><li>End-to-side (proximal) </li></ul></...
<ul><li>SMV-IVC shunt (mesenterico-caval) </li></ul><ul><ul><li>Side-to-side </li></ul></ul><ul><ul><li>H-graft </li></ul>...
Surgical Mx – Intractable Acute Bleeding <ul><li>Direct – control of bleeding site </li></ul><ul><ul><li>Ligation procedur...
Surgical Mx – Miscellaneous <ul><li>Hypersplenism </li></ul><ul><ul><li>Splenectomy </li></ul></ul><ul><li>Ascites </li></...
Thank you
Upcoming SlideShare
Loading in...5
×

Cirrhosis Complications - Surgical Mx

1,193

Published on

Presented in Victoria Hospital, Seychelles in April 2005

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,193
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
47
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Cirrhosis Complications - Surgical Mx

  1. 1. Surgical Management of Complications of Cirrhosis <ul><li>Dr. Sanjoy Sanyal MBBS, MS </li></ul><ul><li>Consultant Surgeon </li></ul><ul><li>Victoria Hospital, </li></ul><ul><li>Ministry of Health, Seychelles </li></ul><ul><li>April 2005 </li></ul>
  2. 2. Complications of Cirrhosis – 1 Portal HTN Gastro- oesophageal varices Bleeding Congestive Splenomegaly (Hypersplenism) Ascites
  3. 3. Complications of Cirrhosis – 2 Cirrhosis Fulminant Hepatic failure Hepatic (Porta-systemic) encephalopathy
  4. 4. Untreated
  5. 5. Surgical Anatomy
  6. 6. Surgical Mx – Direct – Control of Bleeding Varices <ul><li>Ligation of varices </li></ul><ul><ul><li>Trans-thoracic </li></ul></ul><ul><ul><li>Trans-abdominal </li></ul></ul>
  7. 7. Surgical Mx – Direct – Control of Bleeding Varices <ul><li>Transection procedures </li></ul><ul><ul><li>Gastric </li></ul></ul><ul><ul><li>Oesophageal (stapler) </li></ul></ul><ul><ul><li>Oesophageal, with oesophago-gastric devascularization (Sugiura) </li></ul></ul>
  8. 8. Surgical Mx – Direct – Control of Bleeding Varices <ul><li>Resection of varix-bearing area – oesophago-gastrectomy </li></ul><ul><ul><li>Roux-en-Y interposition </li></ul></ul><ul><ul><li>Jejunal interposition </li></ul></ul><ul><ul><li>Colonic interposition </li></ul></ul><ul><ul><li>Reversed gastric tube </li></ul></ul>
  9. 9. Surgical Mx – Indirect – Reduction of Portal Pressure / Flow <ul><li>Porta-caval shunt </li></ul><ul><ul><li>End-to-side </li></ul></ul><ul><ul><li>Side-to-side </li></ul></ul><ul><ul><li>H (jump) graft </li></ul></ul>
  10. 10. <ul><li>Spleno-renal shunt </li></ul><ul><ul><li>End-to-end </li></ul></ul><ul><ul><li>End-to-side (proximal) </li></ul></ul><ul><ul><li>DSRS (selective; Warren) </li></ul></ul>Surgical Mx – Indirect – Reduction of Portal Pressure / Flow
  11. 11. <ul><li>SMV-IVC shunt (mesenterico-caval) </li></ul><ul><ul><li>Side-to-side </li></ul></ul><ul><ul><li>H-graft </li></ul></ul><ul><li>Coronary-caval (selective; Inokuchi) </li></ul>Surgical Mx – Indirect – Reduction of Portal Pressure / Flow
  12. 12. Surgical Mx – Intractable Acute Bleeding <ul><li>Direct – control of bleeding site </li></ul><ul><ul><li>Ligation procedure </li></ul></ul><ul><ul><li>Transection procedure </li></ul></ul><ul><ul><li>Resection procedure </li></ul></ul><ul><li>Indirect – reduction of portal pressure </li></ul><ul><ul><li>Porta-systemic shunts </li></ul></ul>
  13. 13. Surgical Mx – Miscellaneous <ul><li>Hypersplenism </li></ul><ul><ul><li>Splenectomy </li></ul></ul><ul><li>Ascites </li></ul><ul><ul><li>Peritoneo-venous shunt </li></ul></ul><ul><ul><ul><ul><li>Leveen shunt </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Denver shunt </li></ul></ul></ul></ul><ul><li>Hepatic failure </li></ul><ul><ul><li>Liver transplant </li></ul></ul>
  14. 14. Thank you
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×