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

Abstract

Purpose

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 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.

Conclusions

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.

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Acknowledgments

Special thanks to the Department of Radiology and Imaging Sciences at Indiana University School of Medicine for aiding in the development of this study.

Funding

This study was funded, in part, by Award Number T35HL110854 from the National Institutes of Health.

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Authors

Contributions

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.

Corresponding author

Correspondence to Adam Schmitz.

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Conflict of Interest

Dr. Johnson is a paid consultant to Cook Medical. The other authors declare that they have no conflict of interest.

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Schmitz, A., Haste, P. & Johnson, M.S. Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation Prior to Abdominal Operation: a Retrospective Analysis. J Gastrointest Surg 24, 2228–2232 (2020). https://doi.org/10.1007/s11605-019-04384-w

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Keywords

  • Transjugular intrahepatic portosystemic shunt
  • TIPS
  • Surgery
  • Portal hypertension