Surgical Management of Surgical Management of Complications ofComplications of CirrhosisCirrhosis

Dr. Sanjoy Sanyal MBBS, MS

Consultant Surgeon

Victoria Hospital,

Ministry of Health, Seychelles

April 2005

Complications of Cirrhosis – 1Complications of Cirrhosis – 1

Portal HTN

Gastro-oesophageal

varicesBleeding

CongestiveSplenomegaly

(Hypersplenism)Ascites

Complications of Cirrhosis – 2Complications of Cirrhosis – 2

Cirrhosis

FulminantHepaticfailure

Hepatic(Porta-systemic)encephalopathy

UntreatedUntreated

Surgical AnatomySurgical Anatomy

Surgical Mx – Direct – Control of Surgical Mx – Direct – Control of Bleeding VaricesBleeding Varices

Ligation of varices

– Trans-thoracic

– Trans-abdominal

Surgical Mx – Direct – Control Surgical Mx – Direct – Control of Bleeding Varicesof Bleeding Varices

Transection procedures– Gastric– Oesophageal

(stapler)– Oesophageal, with

oesophago-gastric devascularization (Sugiura)

Surgical Mx – Direct – Control Surgical Mx – Direct – Control of Bleeding Varicesof Bleeding Varices

Resection of varix-bearing area – oesophago-gastrectomy

– Roux-en-Y interposition

– Jejunal interposition

– Colonic interposition

– Reversed gastric tube

Surgical Mx – Indirect – Reduction Surgical Mx – Indirect – Reduction of Portal Pressure / Flowof Portal Pressure / Flow

Porta-caval shunt

– End-to-side

– Side-to-side

– H (jump) graft

Spleno-renal shunt– End-to-end– End-to-side (proximal)– DSRS (selective;

Warren)

Surgical Mx – Indirect – Reduction Surgical Mx – Indirect – Reduction of Portal Pressure / Flowof Portal Pressure / Flow

SMV-IVC shunt (mesenterico-caval)– Side-to-side– H-graft

Coronary-caval (selective; Inokuchi)

Surgical Mx – Indirect – Reduction Surgical Mx – Indirect – Reduction of Portal Pressure / Flowof Portal Pressure / Flow

Surgical Mx – Intractable Surgical Mx – Intractable Acute BleedingAcute Bleeding

Direct – control of bleeding site

– Ligation procedure

– Transection procedure

– Resection procedureIndirect – reduction of portal pressure

– Porta-systemic shunts

Surgical Mx – MiscellaneousSurgical Mx – Miscellaneous

Hypersplenism

– SplenectomyAscites

– Peritoneo-venous shunt

–Leveen shunt

–Denver shuntHepatic failure

– Liver transplant

Thank youThank you