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Colorectal Surgery in Cirrhotics

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Surgical Procedures on the Cirrhotic Patient

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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.

The authors have no conflicts of interest or financial ties relevant to the current submission.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA

    Maysoon Gamaleldin MD & Luca Stocchi MD, FACS

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  1. Maysoon Gamaleldin MD
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  2. Luca Stocchi MD, FACS
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Correspondence to Luca Stocchi MD, FACS .

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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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Gamaleldin, M., Stocchi, L. (2017). Colorectal Surgery in Cirrhotics. In: Eghtesad, B., Fung, J. (eds) Surgical Procedures on the Cirrhotic Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-52396-5_15

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  • DOI: https://doi.org/10.1007/978-3-319-52396-5_15

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