Intra-abdominal surgery in patients with advanced cirrhosis
G. V. Aranha and H. B. Greenlee
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.
