Surgery in patients with advanced liver cirrhosis: a Pandora's box.
Advanced liver cirrhosis is a relative contraindication for abdominal surgery, as such patients are likely to develop postoperative complications and mortalities. We describe two patients with liver cirrhosis who developed postoperative decompensation and expired after undergoing non-abdominal surgery. We highlight that even non-abdominal surgery could incur high mortality in patients with Child's class B or C liver cirrhosis. Surgery should be avoided in such patients unless it is absolutely necessary. If the procedure is essential and life-saving, the patient should be co-managed by a team of surgeon, anaesthesist and hepatologist. A full evaluation of the baseline liver status, preoperative optimisation, and close postoperative monitoring are required to reduce the risk of decompensation and improve survival.
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Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074.
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D002481:Cellulitis / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D017114:Liver Failure, Acute / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*