Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation Prior to Abdominal Operation: a Retrospective Analysis
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.
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.
TIPS creation was performed in all 21 patients with a 30-day mortality rate of 9.5%. Eleven patients (52.4%) subsequently underwent abdominal operation after which the 30-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.
In this population, TIPS allowed successful abdominal operation in the majority of patients, with 30-day TIPS mortality of 9.5%, no perioperative mortality, and 9.1% major postoperative morbidity attributable to portal hypertension.
KeywordsTransjugular intrahepatic portosystemic shunt TIPS Surgery Portal hypertension
Special thanks to the Department of Radiology and Imaging Sciences at Indiana University School of Medicine for aiding in the development of this study.
Adam Schmitz made substantial contributions to the design of this study, analyzed the data, and wrote and approved the final manuscript form. In addition, Mr. Schmitz agrees to be accountable for the information presented in this manuscript.
Dr. Paul Haste made substantial contributions to the design of this study, aided in the drafting process, and approved the final manuscript form. In addition, Dr. Haste agrees to be accountable for the information presented in this manuscript.
Dr. Matthew S. Johnson made substantial contributions to the design of this study, aided in the drafting process, and approved the final manuscript form. In addition, Dr. Johnson agrees to be accountable for the information presented in this manuscript.
This study was funded, in part, by Award Number T35HL110854 from the National Institutes of Health.
Compliance with Ethical Standards
Conflict of Interest
Dr. Johnson is a paid consultant to Cook Medical. The other authors declare that they have no conflict of interest.
- 4.De Stefano F, Garcia CR, Gupta M, Marti F, Turcios L, Dugan A, et al. Outcomes in patients with portal hypertension undergoing gastrointestinal surgery: A propensity score matched analysis from the NSQIP dataset. The American Journal of Surgery. 2018.Google Scholar
- 5.Azoulay D, Buabse F, Damiano I, Smail A, Ichai P, Dannaoui M, et al. Neoadjuvant transjugular intrahepatic portosystemic shunt: a solution for extrahepatic abdominal operation in cirrhotic patients with severe portal hypertension. Journal of the American College of Surgeons. 2001;193(1):46–51.CrossRefPubMedGoogle Scholar
- 6.Fares N, Robic MA, Peron JM, Muscari F, Otal P, Suc B, et al. Transjugular intrahepatic portosystemic shunt placement before abdominal intervention in cirrhotic patients with portal hypertension: lessons from a pilot study. European journal of gastroenterology & hepatology. 2018;30(1):21–6.CrossRefGoogle Scholar
- 7.Vinet E, Perreault P, Bouchard L, Bernard D, Wassef R, Richard C, et al. Transjugular intrahepatic portosystemic shunt before abdominal surgery in cirrhotic patients: a retrospective, comparative study. Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 2006;20(6):401–4.CrossRefPubMedPubMedCentralGoogle Scholar