Colorectal Surgery in Cirrhotics

Chapter

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.

Keywords

Colorectal surgery Liver cirrhosis Inflammatory bowel disease Colorectal cancer 

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryDigestive Disease Institute, Cleveland ClinicClevelandUSA

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