Current Principles of Extrahepatic Abdominal Surgery in Cirrhotic Patients: A Narrative Review

Surgical interventions in cirrhotic patients are a relevant problem due to the high rates of perioperative morbidity and mortality. The purpose of this review is to provide up–to-date information on the current principles of extrahepatic abdominal surgery in cirrhotic patients. They are based on stratification of patients by risk groups and a multidisciplinary individual approach to the choice of treatment strategy. The implementation of these provisions includes the use of scores for predicting perioperative risk, diagnosis and possible correction of clinically significant portal hypertension, prophylaxis of infectious complications and postoperative venous thromboembolism, monitoring of coagulopathy and cardiovascular disorders, nutritional support and etiological therapy. When choosing the optimal method of surgical treatment in urgent cases, one should strive to use minimally invasive technologies. If elective operations are considered, a thorough examination of patients is necessary to determine the risk factors for adverse outcome, resolve issues of preoperative preparation, and choice of the scope and timing of the surgical intervention. It can be assumed that the thoughtful implementation of these principles in clinical practice and, in prospect, the use of robotics and artificial intelligence will improve the safety of extrahepatic abdominal surgery in cirrhotic patients.