Management of Patients with Cirrhosis and Portal Hypertension Requiring Surgery

Cirrhosis significantly increases surgical morbidity and mortality as it causes derangement of multiple organ systems and physiological processes. As such, chronic liver disease and the resultant portal hypertension present distinct perioperative challenges. The risk conveyed by liver disease is dependent on its etiology, the severity of liver dysfunction, the degree to which other organ systems are affected, and the type and timing of surgery to be performed. Careful preoperative planning as well as informed intra- and postoperative decision-making strategies are key factors in ensuring acceptable outcomes in the surgical management of cirrhotic patients. This review will discuss the challenges that cirrhosis with portal hypertension presents to the surgeon, intensivist, and anesthesiologist alike, and identifies key perioperative strategies to mitigate these risks.