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Hepatitis
With Hep C and Cirrhosis of liver is gallbladder surgery possible?
Thank you so much for the wealth of information. Weighing all options, I am fearful of the gallbladder creating sepsis or peritonitis. I will check with my Hepatologist on the actual degree of cirrhosis in the liver. Every blood test reveals enzymes and liver functions within normal range. Not sure of the results of last ultra sound (2 weeks ago). I am dealing with the Veteran's Administration, as the result of the Hep C is from gamma globulin (from pooled blood prior to Hep testing in 1987) and the military's infinite wisdom (oxymoron) in deciding I needed that injection.
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Any elective surgery should be postponed if a patient has cirrhosis. (No nose jobs, face lifts, lipo, etc.) I would guess your surgery is needed so that is a different case and should be overseen by a hepatologist or a gastro that understands the risks involved and can plan accordingly.
Make sure the GI (I assume) who has recommended this procedure consults with a hepatologist and the surgeon before any surgery. Anesthesia is also an issue for people with cirrhosis. Most anesthesia is very toxic to the liver. The anesthesiologist must be aware that you have cirrhosis before deciding on the anesthesia to use. There are less harmful to the liver drugs available. Anesthesia can cause decompensation and liver failure if not applied properly.
I only know too well how dangerous it can be. I had compensated cirrhosis with portal hypertension when I had to have surgery for cancer in my foot. Unfortunately with all precautions taken, the anesthesia caused my cirrhosis to decompensate with ascites and hepatic encephalopathy and in a few months I became totally disable and could no longer work. It has been 3 years + now. But I had no choice but have the surgery. The cancer in my foot was more dangerous than my liver disease at the time so I did what I needed to do, aware of the risk I was taking.
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This topic last updated: May 29, 2012
NTRODUCTION — Patients with liver disease who require surgery are at greater risk for surgical and anesthesia related complications than those with a healthy liver [1-4]. The magnitude of the risk depends upon the type of liver disease and its severity, the surgical procedure, and the type of anesthesia.
EFFECTS OF ANESTHESIA AND SURGERY ON THE LIVER — The effects of anesthesia and surgery on the liver depend upon the type of anesthesia used, the specific surgical procedures, and the severity of liver disease. In addition, perioperative events, such as hypotension, sepsis, or the administration of hepatotoxic drugs, can compound injury to the liver occurring during the procedure.
ESTIMATING SURGICAL RISK — Assessment of surgical risk in patients with liver disease includes an appraisal of the severity of liver disease, the urgency of surgery (and alternatives to surgery), and coexisting medical illness. Surgical risk assessment is less relevant if immediate surgery is required to prevent death. On the other hand, the vast majority of decisions are made in the setting of semi-urgent or elective procedures for which there is time for risk assessment, optimization of the patient's medical status, and consideration of alternative approaches.
Patients in whom surgery is contraindicated — A number of settings have been identified that are associated with unacceptable surgical mortality. As a result, these conditions are usually considered to be contraindications to elective surgery.
Severe chronic hepatitis — Surgical risk in patients with chronic hepatitis correlates with the clinical, biochemical, and histologic severity of disease. Patients with symptomatic and histologically severe chronic hepatitis have increased surgical risk, particularly in those with impaired hepatic synthetic or excretory function, portal hypertension, or bridging or multilobular necrosis on liver biopsy.
SUMMARY AND RECOMMENDATIONS — Considering the available data and clinical experience, guidelines for assessing the risk of elective or semi-urgent surgery in patients with liver disease can be suggested:
Medical therapy should be optimized in all patients.
Operative mortality can be estimated based upon the Child classification and the MELD score taking into consideration other factors such as the patient's age, ASA score, and additional comorbidities.
We recommend elective or semi-urgent surgery not be performed in patients with acute or fulminant hepatitis, alcoholic hepatitis, severe chronic hepatitis, Child class C or MELD >15 cirrhosis, severe coagulopathy, or severe extrahepatic manifestations of liver disease (such as hypoxia, cardiomyopathy, or acute renal failure) (Grade 1B).
For other patients, the risk of surgery should be considered individually depending upon the clinical setting and the type of procedure:
Surgery is generally well-tolerated in patients with Child's class A or MELD <10 cirrhosis and those with mild chronic liver disease without cirrhosis.
Surgery is generally permissible in patients with Child's class B or MELD 10-15 cirrhosis (except those undergoing extensive hepatic resection or cardiac surgery) who have undergone thorough preoperative preparation.
Consideration should also be given as to whether surgery can be deferred until after liver transplantation (either orthotopic or live donor) in appropriate candidates."
Please read the entire article here.
http://www.uptodate.com/contents/assessing-surgical-risk-in-patients-with-liver-disease
Just make sure everyone is aware of your cirrhosis. (I always tell the anesthesiologist who comes by before any operation I have cirrhosis and make sure she/he understands this). Make sure all your doctors are aware of our condition and have a gastro or hepatologist experienced with cirrhosis and surgery overlook your procedure so minimal damage is done to your liver.
I hope this help you with at least asking the right questions.
Good luck with your surgery!
Hector