Book chapter
Colorectal Surgery in Cirrhotics
Surgical Procedures on the Cirrhotic Patient, pp.201-214
Springer
2017
DOI: 10.1007/978-3-319-52396-5_15
Abstract
Colorectal surgery in the presence of cirrhosis is associated with overall mortality rates exceeding 20%, which vary proportionally to the severity of cirrhosis. In this respect, Child–Turcotte–Pugh and Model of End Stage Liver Disease (MELD) scores are useful to anticipate perioperative mortality and for patient counseling. Preoperative placement of a transjugular portosystemic shunt may have a role in decreasing perioperative risk in case of portal hypertension, beside medical management. Inflammatory bowel disease associated with primary sclerosing cholangitis can be optimally managed with liver transplant and ileal pouch-anal anastomosis, in no specific order or combination, and depending on the specific severity of the two conditions. The alternative creation of an end ileostomy in this patient population is associated with the risk of developing stomal varices, which can be treated by a variety of local and major operative procedures. Optimal management of stoma varices revolves on the definitive treatment of the associated portal hypertension. The severity of cirrhosis in patients undergoing surgery for colorectal cancer is a more important determinant of overall survival than tumor staging.
Details
- Title: Subtitle
- Colorectal Surgery in Cirrhotics
- Creators
- Maysoon Gamaleldin - Cleveland ClinicLuca Stocchi - Cleveland Clinic
- Contributors
- Bijan Eghtesad (Editor)John Fung (Editor)
- Resource Type
- Book chapter
- Publication Details
- Surgical Procedures on the Cirrhotic Patient, pp.201-214
- DOI
- 10.1007/978-3-319-52396-5_15
- Publisher
- Springer; Cham, Switzerland
- Number of pages
- 14
- Language
- English
- Date published
- 2017
- Academic Unit
- Surgery
- Record Identifier
- 9984966848802771
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