الفهرس 
CIRRHOSISOnly 14 pages are availabe for public view
 |  | from | 197 |  |  |
| | | from | 197 | | |
Abstract
Hepatic resection in cirrhotic liver is difficult but not impossible. In the cirrhotic liver because of the compromised liver function, the functional reserve is less, thus indicating a higher chance of developing post resectional liver failure. The more cirrhotic the liver, the worse is the liver function before operation and the less is the functional reserve. Additionally, it is more challenging because of the intra operative difficulties in mobilising the liver and transecting the liver parenchyma. There may be increased blood loss associated with portal hypertension. Postoperative hepatic failure with increased susceptibility to infection is major concerns.
Cirrhosis also predisposes to multi organ failure following hepatectomy. In cirrhotic patients liver function is the main prognostic factor.
The intra operative mobilization should be limited and removal of the liver tissue should allow tumour clearance but preserve maximal residual volume. An intraoperative USG helps identify small tumours which may not be visible or palpable in a cirrhotic liver on gross examination and helps to identify lesions which are not demonstrated pre operatively. Intra operative USG has been shown to alter the surgical management plan in 18% of cirrhotic patients. Intra operative USG also helps define optimal resection margins.