Surgical portosystemic shunts in the era of TIPS and liver transplantation are still relevant

Gur, Ilia; Diggs, Brian S.; Orloff, Susan L.

doi:10.1111/hpb.12163

Cited by 21 publications

(14 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rosemurgy et al [53] even considered that portal hypertension has disappeared from the purview of surgery and has migrated toward the world of non-surgical therapies, probably never to return. In contrast, Gur et al [54] believed that removing surgical shunts from the surgical armamentarium is premature, and surgical shunts may offer satisfactory control of symptoms and positive long-term prognosis for patients with compensated liver cirrhosis in whom liver transplantation is either premature or not indicated. Thus, the role of surgical shunts remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the development of covered TIPS stents has not only reduced the frequency of shunt dysfunction but has also improved overall survival without increasing the risk of hepatic encephalopathy. [58] Gur et al [54] acknowledged the fact that despite certain shortcomings, TIPS will continue to be considered as a first-line therapy in patients with advanced cirrhosis and variceal bleeding after failed conventional medical therapies and ET. Nevertheless, surgical portosystemic shunts remain an important option in certain circumstances.…”

Section: Discussionmentioning

confidence: 99%

“…[56] In addition, surgical portosystemic shunts may offer unmatched long-term patency, the prevention of re-bleeding, and possibly improved survival in these patients, as well as low operative morbidity and mortality. [54] A recent retrospective study also concluded that surgical portosystemic shunts achieved better results than TIPS with respect to shunt failure-free survival and overall survival in patients with complicated portal hypertension and well preserved hepatic function. [59] Although in our study we are uncertain whether there is a difference in short- or long-term survival or the rate of variceal re-bleeding between surgical portosystemic shunts compared with TIPS owing to few included trials and small sample sizes of the individual included trials, our study indicate that surgical shunts may be at least as safe and efficient as TIPS.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Comparision between portosystemic shunts and endoscopic therapy for prevention of variceal re-bleeding

Zhou

Sun

Lin

et al. 2019

Chinese Medical Journal

View full text Add to dashboard Cite

Background: Portosystemic shunts, including surgical portosystemic shunts and transjugular intra-hepatic portosystemic shunt (TIPS), may have benefit over endoscopic therapy (ET) for treatment of variceal bleeding in patients with cirrhotic portal hypertension; however, whether there being a survival benefit among them remains unclear. This study was to compare the effect of three above-mentioned therapies on the short-term and long-term survival in patient with cirrhosis. Methods: Using the terms “variceal hemorrhage or variceal bleeding or variceal re-bleeding” OR “esophageal and gastric varices” OR “portal hypertension” and “liver cirrhosis,” the Cochrane Central Register of Controlled Trials, PubMed, Embase, and the references of identified trials were searched for human randomized controlled trials (RCTs) published in any language with full texts or abstracts (last search June 2017). Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated using random effects model by Review Manager. The quality of the included studies was evaluated using the Cochrane Collaboration's tool for the assessment of the risk of bias. Results: Twenty-six publications comprising 28 RCTs were included in this analysis. These studies included a total of 2845 patients: 496 (4 RCTs) underwent either surgical portosystemic shunts or TIPS, 1244 (9 RCTs) underwent either surgical portosystemic shunts or ET, and 1105 (15 RCTs) underwent either TIPS or ET. There was no significant difference in overall mortality and 30-day or 6-week survival among three interventions. Compared with TIPS and ET, separately, surgical portosystemic shunts were both associated with a lower bleeding-related mortality (RR = 0.07, 95% CI = 0.01–0.32; P < 0.001; RR = 0.17, 95% CI = 0.06–0.51, P < 0.005) and rate of variceal re-bleeding (RR = 0.23, 95% CI = 0.10–0.51, P < 0.001; RR = 0.10, 95% CI = 0.04–0.24, P < 0.001), without a significant difference in the rate of postoperative hepatic encephalopathy (RR = 0.52, 95% CI = 0.25–1.00, P = 0.14; RR = 1.09, 95% CI = 0.59–2.01, P = 0.78). TIPS showed a trend toward lower variceal re-bleeding (RR = 0.46, 95% CI = 0.36–0.58, P < 0.001), but a higher incidence of hepatic encephalopathy than ET (RR = 1.78, 95% CI = 1.34–2.36, P < 0.001). Conclusions: The overall analysis revealed that there seem to be no short-term and long-term survival advantage, but surgical portosystemic shunts are with the lowest bleeding-related mortality among the three therapies. Surgical portosystemic shunts may be the most effective without an increased risk of hepatic encephalopathy and TIPS is superior to ET but at the cost of a higher incidence of hepatic encephalopathy. However, some of f...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparision between portosystemic shunts and endoscopic therapy for prevention of variceal re-bleeding

Zhou

Sun

Lin

et al. 2019

Chinese Medical Journal

View full text Add to dashboard Cite

show abstract

“…When the conventional transjugular hepatic vein to portal vein approach is not feasible[ 8 , 9 , 24 , 25 ], alternative radiological approaches as well as transhepatic, transplenic and trans-mesenteric have been described. Surgical portosystemic shunt placement for systemic diversion of portal blood has been reported[ 26 ].…”

Section: Discussionmentioning

confidence: 99%

One step minilaparotomy-assisted transmesenteric portal vein recanalization combined with transjugular intrahepatic portosystemic shunt placement: A novel surgical proposal in pediatrics

Pelizzo

Quaretti

Moramarco

et al. 2017

WJG

View full text Add to dashboard Cite

Transjugular intrahepatic portosystemic shunt (TIPS) placement is a standard procedure for the treatment of portal hypertension complications. When this conventional approach is not feasible, alternative procedures for systemic diversion of portal blood have been proposed. A one-step interventional approach, combining minilaparotomy-assisted transmesenteric (MAT) antegrade portal recanalization and TIPS, is described in an adolescent with recurrent esophageal varice bleeding and portal cavernoma (PC). A 16-year-old girl was admitted to our Unit because of repeated bleeding episodes over a short period of time due to esophageal varices in the context of a PC. A portal vein recanalization through an ileocolic vein isolation with the MAT approach followed by TIPS during the same session was performed. In the case of failed portal recanalization, this approach, would also be useful for varice endovascular embolization. Postoperative recovery was uneventful. Treatment consisting of propanolol, enoxaparin and a proton pump inhibitor was prescribed after the procedure. One month post-op, contrast enhanced computed tomography confirmed the patency of the portal and intrahepatic stent grafts. No residual peritoneal fluid was detected nor opacification of the large varices. Endoscopy showed good improvement of the varices. Doppler ultrasound confirmed the accelerated flow in the portal stent and hepatopetal flow inside the intrahepatic portal branches. Three months post-op, TIPS maintained its hourglass shape despite a slight expansion. Portal hypertension and life threatening conditions related to PC would benefit from one-step portal recanalization. MAT-TIPS is feasible and safe for the treatment of PC even in children. This minimally invasive procedure avoids or delays surgical treatment or re-transplantation when necessary in pediatric patients.

show abstract

“…24 Patency rates of MRB range from 60 to 90%, which are lower when compared with PSS. 36,[68][69][70] A favorable intrahepatic portal vein system translates to a greater chance of successful MRB. 71 Additionally, identification of portosystemic collaterals becomes important during surgical planning as they should be ligated during the procedure if they significantly impair portal flow.…”

Section: Role Of Surgical Shunts In Pediatric Patientsmentioning

confidence: 99%

Surgical Portosystemic Shunts: History, Evolution, and Current Applications

López‐Verdugo

Sánchez-García

Gagnon

et al. 2020

Digestive Disease Interventions

View full text Add to dashboard Cite

AbstractMechanical obstruction, thrombus, intrinsic liver disease causing fibrosis or cirrhosis, or an outflow obstruction at the level of the sinusoids or hepatic venous obstruction can cause an increase in pressure or resistance, or both, leading to portal hypertension (PH). Portosystemic shunts (PSS) are usually performed to relieve the congestion that inevitably occurs in the setting of PH. Since their introduction, surgical PSS were often the treatment of choice to prevent recurrent bleeding in patients with clinically significant PH. Development of novel pharmacological therapies, continuous improvement of endoscopic approaches, the introduction of transjugular intrahepatic portosystemic shunt, and advancements in transplantation has provided an evolution in the approach for PH and has precipitated the steady decrease in the proportion of patients needing surgical shunts. Despite this, PSS remain important tools in the surgeon's armamentarium, as they are often employed in the pediatric population with extrahepatic portal vein obstruction and are frequently being used for portal inflow modulation to achieve better portal hemodynamics in resections and transplantation. This has become of great relevance to decrease the risk of small-for-size syndrome and portal hyperperfusion in liver transplantation, and to decrease the risk of posthepatectomy liver dysfunction after major resections in hepatobiliary surgery.

show abstract

Surgical portosystemic shunts in the era of TIPS and liver transplantation are still relevant

Cited by 21 publications

References 28 publications

Comparision between portosystemic shunts and endoscopic therapy for prevention of variceal re-bleeding

Comparision between portosystemic shunts and endoscopic therapy for prevention of variceal re-bleeding

One step minilaparotomy-assisted transmesenteric portal vein recanalization combined with transjugular intrahepatic portosystemic shunt placement: A novel surgical proposal in pediatrics

Surgical Portosystemic Shunts: History, Evolution, and Current Applications

Contact Info

Product

Resources

About