March 1986

Intra-abdominal Surgery in Patients With Advanced Cirrhosis

Author Affiliations

From the Department of Surgery, Loyola University Stritch School of Medicine, Maywood, Ill, and the Surgical Service, Hines (Ill) Veterans Administration Hospital.

Arch Surg. 1986;121(3):275-277. doi:10.1001/archsurg.1986.01400030029003

• Between 1971 and 1984, intra-abdominal surgical procedures were required in 51 patients with cirrhosis who had advanced liver dysfunction and/or ascites. These included the following types of surgery: gastric, 17 patients; small bowel, two patients; colon, five patients; hepatic, nine patients; and pancreas, nine patients. Twelve patients also underwent exploratory celiotomy for an acute condition of the abdomen (six patients) and jaundice (six patients). Patients fell into two groups: (1) those with prothrombin time (PT) greater than 2.5 s over control (24 patients), and (2) those with PT within 2.5 s of control (27 patients). The 30-day mortality rate was 34 (67%) of 51 patients. Nineteen (83%) of 23 patients who had ascites died. Twenty-two (91%) of 24 patients with elevated PT greater than 2.5 s of control died. Twenty-five (86%) of 29 patients who underwent surgery under emergency conditions died. Intraabdominal surgery in decompensated patients with cirrhosis must be undertaken with great caution.

(Arch Surg 1986;121:275-277)