General Surgery in Patients with End-Stage Organ Disease

The number of patients with end-stage organ disease in the United States is substantial. Patients with end-stage organ disease are susceptible to all of the surgical problems seen in general surgical practice, with the added comorbidities associated with their organ failure. Hence, understanding of the principles of perioperative patient management is important as part of a general surgery practice. The chapter contains details on general and peripheral vascular surgical procedures, including dialysis access for patients with end-stage renal disease. Details on management of abdominal hernias, cholelithiasis, and disorders of the intestine in patients with end-stage liver disease are provided. Table 1 discusses the advantages and disadvantages of arteriovenous (AV) fistulas versus AV grafts. Table 2 describes “the rule of 6’s” for mature AV fistula. Table 3 has information on potential barriers to peritoneal dialysis. Table 4 is the Child-Pugh-Turcotte classification of severity of liver disease. Table 5 discusses the factors affecting the decision to operate and timing of operation in patients with end-stage liver disease. Figure 1 shows the increasing incidence of end-stage renal disease in the United States. Figure 2 is the five-stage classification system for chronic kidney disease. Figure 3 illustrates the various options for upper extremity AV fistula. This review contains 3 figures, 5 tables, and 68 references.