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Role of Minimally Invasive Surgery in Patients with Cirrhosis

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Surgical Procedures on the Cirrhotic Patient

Abstract

Patients with cirrhosis and portal hypertension are at increased risk of complications when undergoing surgery in the elective and acute setting for nonliver disease processes. When surgery is necessary in such patients many have previously advocated for traditional open surgery as it was felt that the risk of uncontrolled bleeding with laparoscopy was prohibitive. Recently, increased experience and expertise in laparoscopy, endoscopy, and other minimally invasive interventions has led to a re-evaluation of these ideas. Increasingly, laparoscopic and endoscopic techniques are being utilized in patients with cirrhosis and portal hypertension to ever-greater effect. While such patients still constitute a high-risk population for surgery, the role and utility of minimally invasive surgical techniques continues to grow for these patients. Here we discuss the current knowledge on laparoscopic and endoscopic interventions for cirrhotic patients undergoing general, liver/hepatobiliary, and bariatric surgery as well as newly emerging endoscopic techniques.

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References

  1. Csikesz NG, Nguyen LN, Tseng JF, Shah SA. Nationwide volume and mortality after elective surgery in cirrhotic patients. J Am Coll Surg. 2009;208(1):96–103.

    Article  PubMed  Google Scholar 

  2. Neeff H, Mariaskin D, Spangenberg HC, Hopt UT, Makowiec F. Perioperative mortality after non-hepatic general surgery in patients with liver cirrhosis: an analysis of 138 operations in the 2000s using Child and MELD scores. J Gastrointest Surg. 2011;15(1):1–11.

    Article  PubMed  Google Scholar 

  3. Mansour A, Watson W, Shayani V, Pickleman J. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997 Oct;122(4):730–5.

    Article  CAS  PubMed  Google Scholar 

  4. Teh SH, Nagorney DM, Stevens SR, Offord KP, Therneau TM, Plevak DJ, Talwalkar JA, Kim WR, Kamath PS. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology. 2007;132(4):1261–9.

    Article  PubMed  Google Scholar 

  5. Lopez-Delgado JC, Ballus J, Esteve F, Betancur-Zambrano NL, Corral-Velez V, Mañez R, Betbese AJ, Roncal JA, Javierre C. Outcomes of abdominal surgery in patients with liver cirrhosis. World J Gastroenterol. 2016;22(9):2657–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010;10:CD001546.

    Google Scholar 

  7. Takahara T, Wakabayashi G, Nitta H, Hasegawa Y, Katagiri H, Takeda D, Makabe K, Sasaki A. Laparoscopic liver resection for hepatocellular carcinoma with cirrhosis in a single institution. Hepatobiliary Surg Nutr. 2015;4(6):398–405.

    PubMed  PubMed Central  Google Scholar 

  8. Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P, Dellabona P, et al. Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg. 236:759–67.

    Google Scholar 

  9. Dwivedi A, Chahin F, Agrawal S, Chau WY, Tootla A, Tootla F, Silva YJ. Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease. Dis Colon Rectum. 45:1309–15.

    Google Scholar 

  10. Delis S, Bakoyiannis A, Madariaga J, Bramis J, Tassopoulos N, Dervenis C. Laparoscopic cholecystectomy in cirrhotic patients: the value of MELD score and Child-Pugh classification in predicting outcome. Surg Endosc. 2010;24(2):407–12.

    Article  PubMed  Google Scholar 

  11. Poulsen TL, Thulstrup AM, Sørensen HT, Vilstrup H. Appendicectomy and perioperative mortality in patients with liver cirrhosis. Br J Surg. 2000;87(12):1664–5.

    Article  CAS  PubMed  Google Scholar 

  12. Tsugawa K, Koyanagi N, Hashizume M, Tomikawa M, Ayukawa K, Akahoshi K, Sugimachi K. A comparison of an open and laparoscopic appendectomy for patients with liver cirrhosis. Surg Laparosc Endosc Percutan Tech. 2001;11(3):189–94.

    Article  CAS  PubMed  Google Scholar 

  13. Martínez JL, Rivas H, Delgado S, Castells A, Pique JM, Lacy AM. Laparoscopic-assisted colectomy in patients with liver cirrhosis. Surg Endosc. 2004;18(7):1071–4.

    Article  PubMed  Google Scholar 

  14. Garrison RN, Cryer HM, Howard DA, Polk Jr HC. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg. 199:648–55.

    Google Scholar 

  15. Metcalf AM, Dozois RR, Wolff BG, Beart Jr RW. The surgical risk of colectomy in patients with cirrhosis. Dis Colon Rectum. 1987;30:529–31.

    Article  CAS  PubMed  Google Scholar 

  16. Hedrick TL, Swenson BR, Friel CM. Model for End-stage Liver Disease (MELD) in predicting postoperative mortality of patients undergoing colorectal surgery. Am Surg. 2013;79(4):347–52.

    PubMed  Google Scholar 

  17. Petros Z, Eberhard LR. Liver transplantation and non-alcoholic fatty liver disease. World J Gastroenterol. 2014;20(42):15532–8.

    Article  Google Scholar 

  18. Charlton MR, Burns JM, Pedersen RA, Watt KD, Heimbach JK, Dierkhising RA. Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology. 2011;141:1249–53.

    Article  PubMed  Google Scholar 

  19. Reino DC, Weigle KE, Dutson EP, Bodzin AS, Lunsford KE, Busuttil RW. Liver transplantation and sleeve gastrectomy in the medically complicated obese: new challenges on the horizon. World J Hepatol. 2015;7(21):2315–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pestana L, Swain J, Dierkhising R, Kendrick ML, Kamath PS, Watt KD. Bariatric surgery in patients with cirrhosis with and without portal hypertension: a single-center experience. Mayo Clin Proc. 2015;90(2):209–15.

    Article  PubMed  Google Scholar 

  21. Dallal RM, Mattar SG, Lord JL, Watson AR, Cottam DR, Eid GM, Hamad G, Rabinovitz M, Schauer PR. Results of laparoscopic gastric bypass in patients with cirrhosis. Obes Surg. 2004;14(1):47–53.

    Article  PubMed  Google Scholar 

  22. Shimizu H, Phuong V, Maia M, Kroh M, Chand B, Schauer PR, Brethauer SA. Bariatric surgery in patients with liver cirrhosis. Surg Obes Relat Dis. 2013;9(1):1–6.

    Article  PubMed  Google Scholar 

  23. Mattar SG, Velcu LM, Rabinovitz M, Demetris AJ, Krasinskas AM, Barinas-Mitchell E, Eid GM, Ramanathan R, Taylor DS, Schauer PR. Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg. 2005;242(4):610–7.

    PubMed  PubMed Central  Google Scholar 

  24. Choudhary NS, Puri R, Saraf N, Saigal S, Kumar N, Rai R, Rastogi A, Goja S, Bhangui P, Ramchandra SK, Raut V, Sud R, Soin A. Intragastric balloon as a novel modality for weight loss in patients with cirrhosis and morbid obesity awaiting liver transplantation. Indian J Gastroenterol. 2016;35:113–6.

    Article  PubMed  Google Scholar 

  25. Imaz I, Martínez-Cervell C, García-Alvarez EE, Sendra-Gutiérrez JM, González-Enríquez J. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis Obes Surg. 2008;18:841–6.

    Article  PubMed  Google Scholar 

  26. Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology. 2001;33:802–7.

    Article  CAS  PubMed  Google Scholar 

  27. Lim EJ, Gow PJ, Angus PW. Endoscopic variceal ligation for primary prophylaxis of esophageal variceal hemorrhage in pre-liver transplant patients. Liver Transpl. 2009;15(11):1508–13.

    Article  PubMed  Google Scholar 

  28. De Vries B, Weersma RK. Endoscopic assessment of primary sclerosing cholangitis. Endoscopic assessment of primary sclerosing cholangitis. Minerva Gastroenterol Dietol. 2016;62(1):49–62.

    PubMed  Google Scholar 

  29. Hastier P, Buckley MJ, Francois E, Peten EP, Dumas R, Caroli-Bosc FX, Delmont JP. A prospective study of pancreatic disease in patients with alcoholic cirrhosis: comparative diagnostic value of ERCP and EUS and long-term significance of isolated parenchymal abnormalities. Gastrointest Endosc. 1999 Jun;49(6):705–9.

    Article  CAS  PubMed  Google Scholar 

  30. Inamdar S, Berzin TM, Berkowitz J, Sejapl DV, Sawhney MS, Chutanni R, Pleskow DK, Trindade AJ. Decompensated cirrhosis may be a risk factor for adverse events in endoscopic retrograde cholangiopancreatography. Liver Int. 2016;36:1457–63.

    Article  PubMed  Google Scholar 

  31. Baltz JG, Argo CK, Al-Osaimi AM, Northup PG. Mortality after percutaneous endoscopic gastrostomy in patients with cirrhosis: a case series. Gastrointest Endosc. 2010;72(5):1072–5.

    Article  PubMed  Google Scholar 

  32. Moriwaki Y, Otani J, Okuda J, Niwano T, Sawada Y, Nitta T, Ohshima C. Successful nutritional support for a dysphagic patient with massive cirrhotic ascites and intrathoracic stomach using percutaneous endoscopic gastrostomy (PEG). Nutrition. 2014;30(11–12):1456–9.

    Article  PubMed  Google Scholar 

  33. Lee MJ, Saini S, Brink JA, Morrison MC, Hahn PF, Mueller PR. Malignant small bowel obstruction and ascites: not a contraindication to percutaneous gastrostomy. Clin Radiol. 1991;44:332–4.

    Article  CAS  PubMed  Google Scholar 

  34. Worhunsky DJ, Dua MM, Tran TB, Siu B, Poultsides GA, Norton JA, Visser BC. Laparoscopic hepatectomy in cirrhotics: safe if you adjust technique. Surg Endosc. 2016;19; 4307–14.

    Google Scholar 

  35. Brytska N, Han HS, Shehta A, Yoon YS, Cho JY, Choi Y. Laparoscopic liver resection for hepatitis B and C virus-related hepatocellular carcinoma in patients with Child B or C cirrhosis. Hepatobiliary Surg Nutr. 2015;4(6):373–8.

    PubMed  PubMed Central  Google Scholar 

  36. Chen J, Bai T, Zhang Y, Xie ZB, Wang XB, Wu FX, Li LQ. The safety and efficacy of laparoscopic and open hepatectomy in hepatocellular carcinoma patients with liver cirrhosis: a systematic review. Int J Clin Exp Med. 2015;8(11):20679–89.

    PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of General Surgery, Digestive Disease Surgical Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Naftali Presser MD

  2. Lerner College of Medicine, Department of General Surgery, Digestive Diseases Surgical Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Jeffery L. Ponsky MD, FACS

  3. Cleveland Clinic Lerner College of Medicine, Digestive Disease and Surgery Institute, 9500 Euclid Avenue / A100, Cleveland, OH, 44149, USA

    Jeffery L. Ponsky MD, FACS

Authors
  1. Naftali Presser MD
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  2. Jeffery L. Ponsky MD, FACS
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Correspondence to Jeffery L. Ponsky MD, FACS .

Editor information

Editors and Affiliations

  1. Transplantation Center, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA

    Bijan Eghtesad

  2. Department of Surgery, University of Chicago, Chicago, Illinois, USA

    John Fung

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Presser, N., Ponsky, J.L. (2017). Role of Minimally Invasive Surgery in Patients with Cirrhosis. In: Eghtesad, B., Fung, J. (eds) Surgical Procedures on the Cirrhotic Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-52396-5_9

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  • DOI: https://doi.org/10.1007/978-3-319-52396-5_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52394-1

  • Online ISBN: 978-3-319-52396-5

  • eBook Packages: MedicineMedicine (R0)

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