Surgery in patients with portal hypertension: a preoperative checklist and strategies for attenuating risk

Abstract

Patients with liver disease and portal hypertension are at increased risk of complications from surgery. Recent advances have allowed better optimization of patients with cirrhosis before surgery and a reduction in postoperative complications. Despite this progress, the estimation of surgical risk in a patient with cirrhosis is challenging. The MELD score has shown promise in predicting postoperative mortality compared with the Child-Turcotte-Pugh score. This article addresses current concepts in the perioperative evaluation of patients with liver disease and portal tension, including a preoperative liver assessment (POLA) checklist that may be useful towards mitigating perioperative complications.

Keywords: Ascites; Checklist; Child-Turcotte-Pugh; Cirrhosis; MELD; Portal hypertension; Surgery; TIPS; Variceal bleeding.