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Surgical Procedures for Cirrhosis

Procedures to Manage Cirrhosis

Esophageal varices are like varicose veins. They line the lower esophagus. This is the tube that moves food from the throat to the stomach. They are a common complication of cirrhosis. If the veins rupture, they can cause serious bleeding and the need for a blood transfusion. This can be deadly. Once bleeding is controlled, treatment focuses on preventing it from happening again.

Band Ligation

Endoscopy is used to find the site of bleeding. A narrow tube with a camera on the end is inserted in the throat. A rubber band is then used to tie off the bleeding part of the vein.

Transjugular Intrahepatic Portosystemic Shunting (TIPS)

TIPS is a good choice for bleeding that is not controlled by endoscopy. The TIPS procedure creates an artificial connection between the portal veins and hepatic veins of the liver. This lets the blood bypass blood vessels in the liver on its way back to the heart. This lowers pressure in the veins and varices.

A catheter (tube) with a stent (a tube that shunts blood) attached to it is threaded through a vein in the neck to the liver. X-rays are used to place the stent in the liver. This lets blood flow more easily through the portal vein. Once in place, the shunt allows blood to return directly to the heart.

Other Surgical Shunts

A splenorenal shunt helps lower the pressure in the variceal system by connecting the spleen vein to a kidney vein. A porta-caval shunt lowers pressure in varices by completely bypassing the liver. This is done through a shunt that moves blood returning to the heart from the body into the inferior vena cava (the main vein of the body).

Surgical shunts are used in people who:

  • Have recurrent bleeding varices
  • Cannot be followed closely after TIPS
  • Cannot have a liver transplant

Paracentesis

Severe cirrhosis can cause fluid to build up in the abdomen. Paracentesis is done to take excess fluid out.

A numbing medicine is injected. Imaging is used to help guide the needle and insert it into the belly. Fluid will be drawn out through the needle.

Liver Transplantation

A liver transplant may be needed when:

  • Other methods fail
  • The liver becomes so damaged that it stops working as it should

During a liver transplant, a diseased liver is replaced with a healthy liver from a donor who has died. Sometimes, a portion of the liver from a living, related donor may be used. Medicines will be needed to suppress the immune system and keep it from attacking and damaging the new liver.

REFERENCES:

Cirrhosis. American Liver Foundation website. Available at: http://www.liverfoundation.org/abouttheliver/info/cirrhosis. Accessed January 6, 2021.

Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis. Accessed January 6, 2021.

Cirrhosis of the liver. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/cirrhosis-of-the-liver-31. Accessed January 6, 2021.

Ge PS, Runyon BA. Treatment of Patients with Cirrhosis. N Engl J Med. 2016 Aug 25;375(8):767-777.

Last reviewed December 2020 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD  Last Updated: 1/8/2021