Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation Prior to Abdominal Operation: a Retrospective Analysis
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ORIGINAL ARTICLE
Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation Prior to Abdominal Operation: a Retrospective Analysis Adam Schmitz 1,2
&
Paul Haste 1 & Matthew S. Johnson 1
Received: 12 June 2019 / Accepted: 27 August 2019 # 2019 The Society for Surgery of the Alimentary Tract
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. Keywords Transjugular intrahepatic portosystemic shunt . TIPS . Surgery . Portal hypertension
Introduction Transjugular intrahepatic portosystemic shunt (TIPS) creation is most commonly performed for one of two indications: Previous Presentations This paper was presented in abstract form at the Society of Interventional Radiology 2019 Annual Scientific Meeting, Austin, TX, March 25, 2019 * Adam Schmitz [email protected] Paul Haste [email protected] Matthew S. Johnson [email protected] 1
Department of Radiology, Indiana University School of Medicine, 550 N. University Blvd, Indianapolis, IN 46202, USA
2
Indianapolis, USA
variceal hemorrhage or refractory ascites.1 A third indication that may lead to TIPS creation is portal decompression prior to planned abdominal operation. Cirrhosis is a widely recognized predictor of operative morbidity and mortality, with a recent systematic re
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