Chirurgie digestive (en dehors de la chirurgie hépatique) chez le patient cirrhotique

Gastro-intestinal surgery is feasible in patients with Child A cirrhosis, but is associated with higher morbidity and mortality. Hernia repair, biliary and colonic surgeries are most frequently performed interventions made in this context. Esophageal and pancreatic surgery are more controversial and less frequently performed. For patients with decompensated liver function (Child B or C patients), the indications for surgery should be discussed by a multi-specialty team including the hepatologist, anesthesiologist, surgeon; liver function should be optimized if possible. During emergency surgery, histologic diagnosis of cirrhosis must be confirmed by liver biopsy because of therapeutic and prognostic implications. The management of patients with Child A cirrhosis without portal hypertension is little different from the management of non-cirrhotic patients. However, the management of patients with Child B or C cirrhosis or with portal hypertension is more complex and requires an accurate assessment of the benefice-risk balance of surgical intervention in each case.