Surgical Endoscopy

, Volume 23, Issue 7, pp 1594–1598 | Cite as

Preoperative transjugular intrahepatic portosystemic shunt (TIPS) for cirrhotic patients undergoing abdominal and pelvic surgeries

  • Christine Schlenker
  • Stephen Johnson
  • James F. Trotter



Surgery for patients with cirrhosis is associated with increased morbidity and mortality. Perioperative complications including hemorrhage, wound dehiscence, and peritonitis result from underlying portal hypertension. Perioperative control of portal hypertension could decrease the risk of such complications. This study aimed to describe the authors’ experience with the placement of transjugular intrahepatic portosystemic shunts (TIPS) in patients with cirrhosis to improve surgical outcomes.


A retrospective chart review was performed for seven patients who underwent TIPS placement before elective abdominal or pelvic surgery at the University of Colorado Health Sciences Center from 1998 to 2006. The TIPS indication for each patient was to minimize perioperative complications.


The seven patients in this study underwent their planned surgical procedure within a mean of 13 days from the time of TIPS placement. Two patients required a blood transfusion of two units or less. Three patients experienced a total of four postoperative complications including wound infection, peritonitis, pneumonia, and new ascites. One patient died of liver failure 14 months after surgery.


The preparation of patients with cirrhosis and portal hypertension for elective surgery using preoperative portal decompression may decrease the risk of perioperative morbidity and mortality.


Ascites Cirrhosis Portal hypertension TIPS 


  1. 1.
    Schwartz SI (1981) Biliary tract surgery and cirrhosis: a critical combination. Surgery 90:577–583PubMedGoogle Scholar
  2. 2.
    Aranha GV, Sontag SJ, Greenlee HB (1982) Cholecystectomy in cirrhotic patients: a formidable operation. Am J Surg 143:55–60PubMedCrossRefGoogle Scholar
  3. 3.
    Doberneck RC, Sterling WA Jr, Allison DC (1983) Morbidity and mortality after operation in nonbleeding cirrhotic patients. Am J Surg 146:306–309PubMedCrossRefGoogle Scholar
  4. 4.
    Sirinek KR, Burk RR, Brown M, Levine BA (1987) Improving survival in patients with cirrhosis undergoing major abdominal operations. Arch Surg 122:271–273PubMedGoogle Scholar
  5. 5.
    Lehnert T, Herfarth C (1993) Peptic ulcer surgery in patients with liver cirrhosis. Ann Surg 217:338–346PubMedCrossRefGoogle Scholar
  6. 6.
    Aranha GV, Greenlee HB (1986) Intraabdominal surgery in patients with advanced cirrhosis. Arch Surg 121:275–277PubMedGoogle Scholar
  7. 7.
    Garrison RN, Cryer HM, Howard DA, Polk HC Jr (1984) Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg 199:648–655PubMedCrossRefGoogle Scholar
  8. 8.
    Metcalf AM, Dozois RR, Wolff BG, Beart RW Jr (1987) The surgical risk of colectomy in patients with cirrhosis. Dis Colon Rectum 30:529–531PubMedCrossRefGoogle Scholar
  9. 9.
    del Olmo JA, Flor-Lorente B, Flor-Civera B, Rodriguez F, Serra MA, Escudero A, Lledó S, Rodrigo JM (2003) Risk factors for nonhepatic surgery in patients with cirrhosis. World J Surg 27:647–652PubMedCrossRefGoogle Scholar
  10. 10.
    Jakab F, Rath Z, Sugar I, Ledniczky G, Faller J (1993) Complications following major abdominal surgery in cirrhotic patients. Hepatogastroenterology 40:176–179PubMedGoogle Scholar
  11. 11.
    Wiklund RA (2004) Preoperative preparation of patients with advanced liver disease. Crit Care Med 32(4 Suppl):S106–S115PubMedCrossRefGoogle Scholar
  12. 12.
    Friedman LS (1999) The risk of surgery in patients with liver disease. Hepatology 29:1617–1623PubMedCrossRefGoogle Scholar
  13. 13.
    Moulin G, Champsaur P, Bartoli JM, Chagnaud C, Rousseau H, Monges D (1995) TIPS for portal decompression to allow palliative treatment of adenocarcinoma of the esophagus. Cardiovasc Intervent Radiol 18:186–188PubMedGoogle Scholar
  14. 14.
    Guglielmi A, Girlanda R, Lombardo F, de Manzoni G, Frameglia M, Pelosi G, Baldin M (1999) TIPS allowing for an endoscopic mucosal resection of early gastric cancer in a cirrhotic patient with severe hypertensive gastropathy: report of a case. Surg Today 29:902–905PubMedCrossRefGoogle Scholar
  15. 15.
    Gil A, Martinez-Regueira F, Hernandez-Lizoain JL, Pardo F, Olea JM, Bastarrika G, Cienfuegos JA, Bilbao JI (2004) The role of transjugular intrahepatic portosystemic shunt prior to abdominal tumoral surgery in cirrhotic patients with portal hypertension. Eur J Surg Oncol 30:46–52PubMedCrossRefGoogle Scholar
  16. 16.
    Azoulay D, Buabse F, Damiano I, Smail A, Ichai P, Dannaoui M, Castaing D, Bismuth H (2001) Neoadjuvant transjugular intrahepatic portosystemic shunt: a solution for extrahepatic abdominal operation in cirrhotic patients with severe portal hypertension. J Am Coll Surg 193:46–51PubMedCrossRefGoogle Scholar
  17. 17.
    Mansour A, Watson W, Shayani V, Pickleman J (1997) Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery 122:730–735PubMedCrossRefGoogle Scholar
  18. 18.
    Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL (1999) Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology 90:42–53PubMedCrossRefGoogle Scholar
  19. 19.
    Allard JP, Chau J, Sandokji K, Blendis LM, Wong F (2001) Effects of ascites resolution after successful TIPS on nutrition in cirrhotic patients with refractory ascites. Am J Gastroenterol 96:2442–2447PubMedCrossRefGoogle Scholar
  20. 20.
    Trotter JF, Suhocki PV, Rockey DC (1998) Transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory ascites: effect on body weight and Child-Pugh score. Am J Gastroenterol 93:1891–1894PubMedCrossRefGoogle Scholar
  21. 21.
    Rossle M, Ochs A, Gulberg V, Siegerstetter V, Holl J, Deibert P, Olschewski M, Reiser M, Gerbes AL (2000) A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med 342:1701–1707PubMedCrossRefGoogle Scholar
  22. 22.
    Ochs A, Rossle M, Haag K, Hauenstein KH, Deibert P, Siegerstetter V, Huonker M, Langer M, Blum HE (1995) The transjugular intrahepatic portosystemic stent–shunt procedure for refractory ascites. N Engl J Med 332:1192–1197PubMedCrossRefGoogle Scholar
  23. 23.
    Tripathi D, Helmy A, Macbeth K, Balata S, Lui HF, Stanley AJ, Redhead DN, Hayes PC (2004) Ten years’ follow-up of 472 patients following transjugular intrahepatic portosystemic stent–shunt insertion at a single centre. Eur J Gastroenterol Hepatol 16:9–18PubMedCrossRefGoogle Scholar
  24. 24.
    Chalasani N, Clark WS, Martin LG, Kamean J, Khan MA, Patel NH, Boyer TD (2000) Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting. Gastroenterology 118:138–144PubMedCrossRefGoogle Scholar
  25. 25.
    Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC (2000) A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 31:864–871PubMedCrossRefGoogle Scholar
  26. 26.
    Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP (1993) Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review. Radiographics 13:1185–1210PubMedGoogle Scholar
  27. 27.
    Wong F, Sniderman K, Liu P, Allidina Y, Sherman M, Blendis L (1995) Transjugular intrahepatic portosystemic stent shunt: effects on hemodynamics and sodium homeostasis in cirrhosis and refractory ascites. Ann Intern Med 122:816–822PubMedGoogle Scholar
  28. 28.
    Wolff M, Hirner A (2003) Current state of portosystemic shunt surgery Langenbecks. Arch Surg 388:141–149CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Christine Schlenker
    • 1
  • Stephen Johnson
    • 2
  • James F. Trotter
    • 3
  1. 1.Division of GastroenterologyUniversity of Washington Medical Center SeattleUSA
  2. 2.Department of RadiologyUniversity of Colorado Health Sciences CenterAuroraUSA
  3. 3.Division of Gastroenterology/HepatologyUniversity of Colorado Health Sciences CenterAuroraUSA

Personalised recommendations