The Surgical Risk in Cirrhosis of the Liver

Lindenmuth, W. W.

doi:10.1001/archsurg.1963.01310080059014

Cited by 18 publications

(1 citation statement)

References 4 publications

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“…With a relatively high risk of mortality following even minor procedures, there is no such thing as a benign operation in the setting of cirrhosis. 1–5 Not surprisingly, when occult advanced liver disease is discovered at the time of laparotomy, the planned procedure is often aborted. However, high perioperative mortality remains for even exploratory laparotomy alone.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Negative Intraoperative Findings at Emergent Laparotomy in Patients with Cirrhosis

Tapper

Patwardhan

Mazer

et al. 2014

Journal of Gastrointestinal Surgery

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Background Emergent surgery in the setting of decompensated cirrhosis is highly morbid. We sought to determine the clinical factors associated with negative intraoperative findings at emergent laparotomy. Methods We performed a retrospective cohort study of consecutive inpatients with a diagnosis of cirrhosis (ICD-9 571) admitted to the Beth Israel Deaconess Medical Center (Boston, MA) who underwent emergent, nonhepatic, abdominal surgery between May 6, 2005 and September 3, 2012. Results Eighty-six patients with cirrhosis were included with a mean model for end-stage liver disease score of 21.3±7.95 and a 90-day mortality rate of 39.5 %. Twelve (16.2 %) patients had negative laparotomies. Negative intraoperative findings were independently associated with (1) paracentesis prior to a preoperative diagnosis of perforated viscus (P=0.006), (2) development of an indication for emergent surgery after 24 h into hospital admission for another reason (P=0.020), and (3) a preoperative diagnosis of bowel ischemia (P=0.005), with odds ratios of 10.1 (CI 1.92–66.83), 5.80 (CI 1.32–33.39), and 11.1 (CI 2.08–77.4), respectively. Free air on computed tomography (CT) imaging was found in 64.3 % (9/14) of patients who had a paracentesis within the preceding 48 h compared to 10.1 % (7/72) among patients who did not undergo a paracentesis (P<0.001). Only 45 % of patients with free air following a paracentesis had positive findings at laparotomy compared to 100 % in those without a preceding paracentesis (P=0.038). Negative laparotomy was independently predictive of in-hospital mortality (OR 4.7; P= 0.034). Conclusion The possibility of a negative laparotomy is suggested by preoperative clinical factors. In particular, free air following a paracentesis does not necessarily indicate that operative intervention is required. Consideration of close observation before laparotomy in these patients is reasonable.

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Section: Introductionmentioning

confidence: 99%

Predictors of Negative Intraoperative Findings at Emergent Laparotomy in Patients with Cirrhosis

Tapper

Patwardhan

Mazer

et al. 2014

Journal of Gastrointestinal Surgery

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Gray-Scale Ultrasonography and Thin-Needle Cholangiography

Goldstein¹,

Sample²,

Kadell³

et al. 1977

JAMA

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Adverse effects of exploratory laparotomy in patients with unsuspected liver disease

Powell-Jackson¹,

Greenway²,

Williams³

1982

British Journal of Surgery

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Thirty-six patients were referred to the Liver Unit between 1971 and 1980 after unsuspected liver disease had been found at laparotomy. The preoperative diagnosis had been extrahepatic biliary obstruction in 16 patients and intra-abdominal malignancy in 15. Misdiagnosis resulted from insufficient attention to the history and physical signs in 31 patients and omission or misinterpretation of liver function tests and of other hepatobiliary investigations in the remaining 5 patients. The morbidity and mortality of the 36 patients within 1 month of operation was 61 per cent and 31 per cent respectively. All patients with viral or alcoholic hepatitis died, and severe complications, which included bacterial peritonitis, wound dehiscence and hepatic failure, developed in 13 of 15 in whom ascites due to cirrhosis or the Budd-Chiari syndrome was present before operation.

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The Surgical Risk in Cirrhosis of the Liver

Cited by 18 publications

References 4 publications

Predictors of Negative Intraoperative Findings at Emergent Laparotomy in Patients with Cirrhosis

Predictors of Negative Intraoperative Findings at Emergent Laparotomy in Patients with Cirrhosis

Gray-Scale Ultrasonography and Thin-Needle Cholangiography

Adverse effects of exploratory laparotomy in patients with unsuspected liver disease

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