Sarah Bos

65 Hemostatic complications in hepatobiliary surgery 5 Introduction Hepatobiliary surgery is associated with a substantial risk of bleeding and thrombotic complications. Given the central role of the liver in hemostasis, it is not surprising that hemostatic changes occur during and after partial hepatectomy or liver transplantation. Also, preoperative hemostatic abnormalities are frequently present in patients with the (end-stage) liver disease.(1) Bleeding during partial hepatectomy may be largely due to surgical and anatom- ical factors, but perioperative changes in the hemostatic system may also con- tribute.(2,3) During liver transplant surgery, the substantially altered hemostatic system may contribute to bleeding, although surgical and anesthesiological fac- tors and portal hypertension contribute significantly.(4,5) The risk of deep vein thrombosis following hepatobiliary surgery is not negligible, even in patients re- ceiving adequate thromboprophylaxis.(6) In liver transplant recipients, thrombotic complications of the hepatic artery or portal vein may occur, and may directly compromise graft function and vitality.(7,8) Prevention and treatment of bleeding and thrombosis, therefore, are essential in the management of patients undergo- ing hepatobiliary surgery. In the past decade, clinical and laboratory studies have led to a better understand- ing of the status of the hemostatic system of the patient undergoing hepatobiliary surgery. These new insights are significant to further optimize clinical manage- ment.(9,10) In this article, we will provide an overview of the new insights in hemostatic changes during hepatobiliary surgery. Also, developments in understanding risk factors and the possible predictors of hemostatic complications during the perioperative period of hepatobiliary surgery will be discussed. Finally, strategies for prevention and treatment of bleeding and thrombotic complications will be summarized.