Surgery in patients with cirrhosis.

Within the past decade it has been found two of the chief causes of death in cirrhotic patients are partially amenable to treatment. Infection, which formerly killed approximately one-third of the patients with portal cirrhosis, can now be well controlled by antibiotic therapy. The incidence of exsanguinating hemorrhage from varices, which accounted for another third of the deaths in cirrhotic patients, has been lessened considerably by the development of various shunting procedures and direct surgical attack on the varices themselves. Hence, many cirrhotic patients may now be expected to live longer, ultimately developing other disorders which may require elective or emergency surgery. Surgeons have noted that patients with unsuspected extensive liver damage often tolerate major surgical procedures well. More recently, patients with known liver disease and portal hypertension have successfully undergone a considerable amount of surgical trauma during shunting procedures. These recent findings suggest that we should reevaluate