Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation Prior to Abdominal Operation: a Retrospective Analysis

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) creation is most commonly performed for patients with refractory ascites or variceal hemorrhage. While TIPS have also been created prior to planned abdominal operation to decrease morbidity related to portal hypertension, there are limited data supporting its effectiveness in that indication. The goal of this study was to determine if preoperative TIPS creation allows for successful abdominal operation with limited morbidity. Methods: A retrospective review of records of 22 consecutive patients who underwent TIPS creation for the specific indication of improving surgical candidacy, between 2011 and 2016, was performed. Clinical and serologic data were obtained for 21 patients (one patient was excluded since she was completely lost to follow up after TIPS creation). The primary endpoint was whether patients underwent planned abdominal operation following TIPS. Operative outcomes and reasons that patients failed to undergo planned operation were examined as secondary endpoints. The mean age was 56.4 ± 8.8 years, and the mean Child-Pugh and Model for End-Stage Liver Disease (MELD) scores were 7.2 ± 1.5 and 11.9 ± 4.3, respectively. Results: TIPS creation was performed in all 21 patients with a thirty-day mortality rate of 9.5%. Eleven patients (52.4%) subsequently underwent abdominal operation after which the thirty-day postoperative mortality rate was 0%. One patient (9.1%) had major perioperative morbidity related to portal hypertension and presented with surgical wound dehiscence and infection requiring drain placement and antibiotic therapy. Conclusions: In this population, TIPS allowed successful abdominal operation in the majority of patients, with thirty-day TIPS mortality of 9.5%, no perioperative mortality, and 9.1% major postoperative morbidity attributable to portal hypertension.

Preoperative TIPS prevents the development of postoperative acute-on-chronic liver failure in patients with high CLIF-C AD score

“…Current data indicate that lowering of HVPG by TIPS before surgery may indeed increase the feasibility of planned surgeries in 52–85% of the patients. [25] , [26] , [27] , [28] However, only 2 studies addressed postoperative outcome in patients with TIPS compared with those without. 26 , 29 Unfortunately, the cohorts were matched neither for ASA score nor for liver function, resulting in significantly different Child-Pugh scores between the compared groups and not showing a significant difference in postoperative survival.…”

TIPSS as a bridge to extrahepatic abdominal surgery: a case report

“…Cirrhotic patients with portal hypertension present a unique challenge, often having co-morbidities that complicate management [ 5 ]. High rates of surgical morbidity and mortality have been reported in patients with cirrhosis undergoing various surgical procedures [ 6 ].…”

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

“…The outcome is mainly influenced by the severity of liver disease, type of surgery, and the degree of PH[ 138 , 139 ]. Pre-operative TIPS may reduce the portal pressure and decrease the risk of bleeding as well as help in managing pre-or-post operative ascites[ 140 - 147 ]. The optimal time between TIPS and the performance of surgery is controversial.…”

“…That being, the perceived benefit of TIPS must be weighed against the risk of the procedure itself and the associated time delay. All publications on the role of pre-operative TIPS are retrospective in the form of single clinical reports or case series with a fairly small number of patients[ 140 - 147 ]. Out of these, only two studies have had a control group, but both were retrospective comparative studies without randomization[ 143 , 146 ].…”