**6. Patients with cirrhotic diseases**

Liver diseases are always considered risk factors in operations due to increase risks of complications and sometimes can even be the cause of death. Liver decompensation is also one reason why clinicians are hesitant to recommend surgeries due to the possible occurrence of abnormal clearance of proteins, abnormal excretion, ascites and portal hypertension. [11]

There are also factors being considered such as the patients Child-Pugh score, the length and extent of the surgery as well as postoperative complications.[23] The Child-Pugh score is used to evaluate and assess the condition of a patient with liver disease as well as predict mortality during surgery. Nowadays it is also used to establish the prognosis and the required treatment for the disease. [23]

Another recent assessment tool is the Model for End-Stage Liver Disease, or MELD, a scoring system for assessing the severity of chronic liver disease. This system uses the patient's values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict the patient's survival after surgery. [11]
