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