ABSTRACT
Background: Cirrhotic patients have an increased surgical risk due to potential intra and postoperative complications. Aim: To describe the clinical characteristics and surgical complications of cirrhotic patients undergoing surgery in a Chilean university hospital. Patients and Methods: Review of medical records of 102 cirrhotic patients aged 60 ± 11 years (52% males) who underwent elective or urgency surgery at an university hospital between 2010 and 2016. General, pre-surgical, and post-surgical complications were recorded. Results: The main etiologies of cirrhosis were non-alcoholic steatohepatitis (31%), and alcoholic cirrhosis (28%). Child-Pugh scores were A, B and C in 50, 28 and 22% of cases respectively. Median MELD (Model for End-stage Liver Disease) score was 11 (interquartile range: 10-15). The surgical procedure was elective in 71% of cases, with predominance of abdominal surgery (86%). The American Society of Anesthesiologists (ASA) score was three or more in 52% of patients. The frequency of any adverse outcome was 62%. The frequency increased along with the severity of cirrhosis and when surgery was urgent. The most common complications were acute renal failure (24%), increased ascites (23%) and encephalopathy (22%). Admission to intensive care unit occurred on 26% of patients, with six hospital deaths. Conclusions: In these patients, surgical complications were common, although with low mortality.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , End Stage Liver Disease , Severity of Illness Index , Chile/epidemiology , Elective Surgical Procedures , Liver Cirrhosis/surgery , Liver Cirrhosis/complicationsABSTRACT
Se estudiaron 21 pacientes portadores de cáncer gástrico, sometidos a gastrectomía total, entre septiembre 1983 y agosto de 1984 a los cuales se les colocó una sonda de alimentación naso yeyunal durante la intervención. Se inició la alimentación enteral (AE) con dieta semielemental (Hipalen 1000R) al 6 día postoperatorio, manteniéndola por 9,9 días (promedio). La tolerancia fue buena en 17 pacientes; 2 pacientes presentaron diarrea, uno regurgitación y otro, dolor abdominal, no siendo necesario suspender AE en ninguno de ellos. No se observó cambios significativos, pre y postoperatorios en los parámetros antropométricos y bioquímicos evaluados, 2 pacientes presentaron fístula anastomótica que cerró con manejo médico. Fallecen 2 pacientes (9,5%) por complicaciones sépticas, los 19 restantes reinician alimentación oral entre el 7 y 23 día. Esta técnica de alimentación enteral postoperatoria no registró morbilidad agregada en la evolución de los pacientes sometidos a gastrectomía total, permitiendo suspender la alimentación parenteral precozmente, mantener en cifras normales los índices nutricionales evaluados; es de bajo costo, fácil preparación y administración y presenta buena tolerancia. Por los resultados obtenidos recomendamos su uso rutinario en pacientes sometidos a gastrectomía total.