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Cirrhosis Complications - Surgical Mx
 

Cirrhosis Complications - Surgical Mx

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Presented in Victoria Hospital, Seychelles in April 2005

Presented in Victoria Hospital, Seychelles in April 2005

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    Cirrhosis Complications - Surgical Mx Cirrhosis Complications - Surgical Mx Presentation Transcript

    • 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
    • Surgical Mx – Direct – Control of Bleeding Varices
      • Transection procedures
        • Gastric
        • Oesophageal (stapler)
        • Oesophageal, with oesophago-gastric devascularization (Sugiura)
    • Surgical Mx – Direct – Control of Bleeding Varices
      • 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)
      Surgical Mx – Indirect – Reduction of Portal Pressure / Flow
      • SMV-IVC shunt (mesenterico-caval)
        • Side-to-side
        • H-graft
      • Coronary-caval (selective; Inokuchi)
      Surgical Mx – Indirect – Reduction of Portal Pressure / Flow
    • 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