Surgical evaluation of histology assessment of activity in cirrhosis: a suggested grading system

ABSTRACT

Histopathological assessment of activity in liver cirrhosis, is a very important parameter amongst others, in the determination of the clinical and surgical outcome of patients. The currently used Modified Child's classification, is a clinicolaboratory scoring system [Pugh et al, 1973], which does not include the variable of activity. As there is no sharp distinction between chronic active hepatitis and cirrhosis with activity; the latter has now been termed as active cirrhosis; and cirrhosis divided into active or inactive irrespective of the aetiological factor. In this study 60 cases of Modified Child A and B categories, with past history of bleeding varices, were subjected to splenectomy and devascularization. A wedge biopsy was submitted for histopathologic examination, to determine the degree of activity, the most marked of which has been termed grade III, moderate grade II, mid grade I and absent activity as cirrhosis grade 0. G 0 and G I cases passed through a smooth postoperative period, whilst G II and G III cases showed high mortality and morbidity rates. Numerical consideration of the activity grade in conjunction with Modified Child's score is tried. There is a statistically significant change in categorization and surgical outcome in the mortality and morbidity cases. A preoperative pathological grading of activity, via needle biopsy is hence advisable. This important parameter has to be considered in conjunction with the Modified Child's scoring system, as it reflects system, as it reflects itself heavily on both categorization and the surgical outcome: