Hemostasiologic Changes during Hepatobiliary Surgery in Patients with Obstructive Jaundice: Pathophysiology and Clinical Considerations

Abstract

Aim: The aim of this article was to present an overview of the hemostaseologic changes in patients with obstructive jaundice undergoing bile duct and hepatic surgery, with respect to the risk assessment for developing postoperative liver insufficiency, intraoperative and postoperative hemorrhage or thrombembolism. Source: Relevant articles from the MEDLINE databases (1976-2010) were extracted and reviewed, using the following key words: “obstructive jaundice”, “liver resections”, “hemostasis”, “perioperative hemostaseologic changes”, “perioperative bleeding”, “liver insufficiency”, and “perioperative thromboembolism”.Main findings: The development of intraand postoperative hemorrhages and the occurrence of thromboembolic incidents in patients with obstructive jaundice are due to changes in coagulation and fibrinolysis. They depend on the etiopathogenesis of the main disease and inflammatory changes in the biliary system, as well as on the duration of mechanical obstruction and the scope of surgical intervention. The occurrence of perioperative hemostatic complications does not always correlate with the extent of abnormalities in the analyzed perioperative laboratory hemostaseologic parameters. Conclusion: Further research of the association between perioperative hemostaseologic changes in patients with obstructive jaundice of malignant and benign origin would contribute to the risk assessment of possible intraand postoperative hemostatic complications and liver insufficiency, as well as to the prophylaxis of these complications.