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Surgical Procedures for Cirrhosis
Procedures for Managing Cirrhosis
Esophageal varices are similar to varicose veins except that they occur in the lining of the walls of the lower esophagus, the tube moves food from your throat to your stomach. They are a common complication of cirrhosis. If the veins rupture, they can cause serious bleeding that often requires blood transfusion. Once bleeding is controlled, treatment focuses on preventing future bleeding episodes. Ruptured esophageal varices are responsible for a large proportion of the deaths associated with cirrhosis.
Endoscopy, which consists of a narrow tube mounted with a video camera being inserted into the throat, is used to identify the bleeding site. A rubber band is used to tie off the bleeding portion of the vein.
Transjugular Intrahepatic Porto-Systemic Shunting (TIPS)
This procedure is done under 2 conditions:
- Abdominal fluid which does not respond to standard medical treatment
- Acute bleeding from esophageal varices unresponsive to standard medical or endoscopic treatment
The TIPS procedure is the creation of an artificial connection directly between the portal veins and hepatic veins of your liver. The entire procedure is performed using needles, catheters, wires, and stents placed through a vein in your neck.
In this procedure, a catheter (tube) with a stent (a tube that shunts blood) attached to it is threaded through a vein in your neck into your liver. Using x-ray guidance, the stent is placed within your liver to allow blood to flow more easily through the portal vein. Once in place, the shunt allows blood to return directly to your heart without passing through the varices. TIPS is a good choice for bleeding that is not controlled by endoscopy.
Other Surgical Shunts
The splenorenal shunt helps to reduce the pressure within the variceal system by connecting the spleen vein to a kidney vein. On the other hand, portacaval shunt reduces pressure in the entire portal system by connecting the portal vein to the inferior vena cava.
These procedures are considered for people who:
- Cannot be followed closely after TIPS
- Are not a candidate for liver transplant
- Have recurrent bleeding varices
Paracentesis simply takes fluid out from the abdominal cavity.
In this procedure, a soft catheter is inserted into the abdomen. Usually when large volumes of fluid are to be removed, human albumin is introduced into the abdominal cavity. Complications from this procedure include: catheter-related injury to the intestine, bleeding, infection, or a drop in blood pressure.
A liver transplant may be necessary when:
- Complications of cirrhosis cannot be controlled with medical therapy
- The liver becomes so damaged that it completely stops functioning
During a liver transplant, a diseased liver is replaced with a healthy liver from a donor who has died. In some cases, a portion of the liver of a living, related donor may be used. Survival rates have improved because of drugs that suppress the immune system and keep it from attacking and damaging the new liver.
Endoscopy is again used to identify the bleeding site. It is only useful if the bleeding is in your esophagus. A drug is injected into the bleeding vein, causing it to constrict. This slows the bleeding and allows a clot to form, closing the ruptured vessel. It is necessary to repeat the procedure over 2-3 months to reduce the risk of bleeding again. This procedure is rarely used.
Cirrhosis. American Liver Foundation website. Available at: http://www.liverfoundation.org/abouttheliver/info/cirrhosis. Updated December 3, 2012. Accessed April 24, 2013.
Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/liver-disease/cirrhosis/Pages/facts.aspx. Updated February 21, 2012. Accessed April 24, 2013.
Cirrhosis of the liver. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 27, 2012. Accessed April 24, 2013
Liver surgery. Keck School of Medicine of USC Department of Surgery website. Available at: http://www.surgery.usc.edu/hepatobiliary/liversurgery.html. Accessed February 27, 2014.
Orloff MJ, Isenberg JL, Wheeler HO, et al. Randomized trial of emergency endoscopic slcerotherapy versus emergency portacaval shunt for acutely bleeding esophageal varices in cirrhosis. J Am Coll Surg. 2009;209(1):25-40.
Starr SP, Raines D. Cirrhosis: diagnosis, management, and prevention. Am Fam Physician. 2011;84(12):1353-1359.
Runyon BA, AASLD Practice Guidelnes Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology. 2009;49(6):2087-2107.
- Reviewer: Daus Mahnke, MD
- Review Date: 03/2016
- Update Date: 03/15/2015