Elective Indications

Elective operations (done in stable patients with no evidence of bleeding for at least 48 h) should only be performed in patients with adequate liver reserve (Child-Pugh Class A-B+). Those with advanced liver disease may be better served with liver transplanta-

Table 1

Child-Pugh Classification of Severity of Liver Disease

Table 1

Child-Pugh Classification of Severity of Liver Disease

Parameter

1 Point

2 Points

3 Points

Bilirubin (mg/dL)

<2

2-

3

>3

Albumin (g/dL)

>3.5

2.8-

3.5

<2.8

Increased Prothrombin time (s)

1-3

4-

-6

>6

Ascites

None

Slight

Moderate

Encephalopathy

None

1-

2

3-4

Grades: A = 5-6 points B = 7-9 points C = 10-15 points

Grades: A = 5-6 points B = 7-9 points C = 10-15 points tion, although donor organ shortage is a continual problem. For good-risk patients who have failed repeated sclerotherapy or those with gastric varices, surgical shunting is indicated for the prevention of recurrent variceal hemorrhage. Our preference is to perform the DSRS if the patient's anatomy is favorable, and if there is no significant ascites. The small-diameter MCS is a second alternative. We try to avoid the PCS in order to preserve the option of liver transplantation in the future.

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