Position paper on perioperative management and surgical risk in the patient with cirrhosis.

J A Velarde-Ruiz Velasco, J Pérez-Escobar, J Meza-Cardona, Y I López-Méndez, J E Lira-Vera, N J Fernández Pérez, A Montaño-Loza, J Crespo, A D Cano-Contreras, F Higuera-de-la-Tijera, R Moreno-Alcántar, J M Aldana-Ledesma, D K Tapia-Calderón, G E Castro-Narro, E S García-Jiménez, J L Pérez-Hernández, E Cerda-Reyes

Journal: Revista de gastroenterologia de Mexico (English) 2024;89(3):418-441

PMID: 39003101

Free Full Text on Elsevier Science View on PubMed

Abstract

INTRODUCTION

Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context.

AIMS

The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients.

RESULTS

Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care.

CONCLUSIONS

The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.

Address: Servicio de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.; Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.; División de Gastroenterología y Hepatología, Hospital de la Universidad de Alberta, Alberta, Canada.; Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, Veracruz, Mexico.; Hospital Central Militar, Mexico City, Mexico.; Hospital Ángeles León, León, Guanajuato, Mexico.; Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.; Servicio de Gastroenterología y Hepatología, Hospital Central «Dr. Ignacio Morones Prieto», San Luis Potosí, San Luis Potosí, Mexico.; Departamento de Gastroenterología, Medica Sur, Mexico City, Mexico.; Departamento de Gastroenterología, Hospital Español, Mexico City, Mexico.; Departamento de Gastroenterología, Hospital de Especialidades «Dr. Bernando Sepúlveda», UMAE Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico.; Servicio de Gastroenterología y Unidad de Trasplante Hepático, Hospital Juárez de México, Mexico City, Mexico.; Servicio de Gastroenterología y Hepatología, Hospital General de México «Dr. Eduardo Liceaga», Mexico City, Mexico.; Servicio de Gastroenterología y Hepatología, Hospital General de México «Dr. Eduardo Liceaga», Mexico City, Mexico. Electronic address: [email protected].

DOI: 10.1016/j.rgmxen.2024.05.001

Link outs

Free resources

Full Text Sources:

https://linkinghub.elsevier.com/retrieve/pii/S2255...

Medical:

https://medlineplus.gov/cirrhosis.html

MeSH Terms: Humans, Liver Cirrhosis, Perioperative Care, Mexico, Postoperative Complications