Abdominal operations in patients with cirrhosis: still a major surgical challenge

Surgery. 1997 Oct;122(4):730-5; discussion 735-6. doi: 10.1016/s0039-6060(97)90080-5.


Background: Hepatic transplantation and portasystemic shunts can be safely performed in patients with advanced liver disease, whereas other abdominal procedures appear to have a much higher mortality rate. This study reviews the outcomes of patients with cirrhosis after the full spectrum of abdominal operations.

Methods: In a 12-year period, 92 patients diagnosed with cirrhosis required either an emergent or elective abdominal operation. There were four categories of operations: cholecystectomy in 17 patients, hernia in 9, gastrointestinal tract in 54, and other procedures in 12. Fifty-five clinical, laboratory, and operative variables were analyzed to identify factors predictive of poor outcome.

Results: Coagulopathy developed in 24 patients (27%) and sepsis in 15 (16%). The mortality rate after emergent operations was 50%, compared to 18% for elective cases (p = 0.001). Other factors that predicted mortality included the presence of ascites (p = 0.006), encephalopathy (p = 0.002), and elevated prothrombin time (p = 0.021). The mortality in Child's class A patients was 10%, compared to 30% in class B and 82% in class C patients.

Conclusions: Patients with cirrhosis undergoing elective or emergent operations are at a significant risk of developing postoperative complications leading to death. The most accurate predictor of outcome is the patient's preoperative Child's class.

MeSH terms

  • Abdomen, Acute / surgery*
  • Adult
  • Biopsy
  • Cholecystectomy* / mortality
  • Female
  • Gastrointestinal Hemorrhage / surgery*
  • Humans
  • Liver Cirrhosis / classification
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis, Alcoholic / classification
  • Liver Cirrhosis, Alcoholic / complications*
  • Liver Cirrhosis, Alcoholic / pathology
  • Male
  • Middle Aged
  • Surgical Procedures, Operative / mortality
  • Wounds, Nonpenetrating / surgery*
  • Wounds, Penetrating / surgery*