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Surgical Endoscopy

, Volume 27, Issue 8, pp 2712–2720 | Cite as

Transjugular intrahepatic portosystemic shunt (TIPS) versus laparoscopic splenectomy (LS) plus preoperative endoscopic varices ligation (EVL) in the treatment of recurrent variceal bleeding

  • Jin Zhou
  • Zhong Wu
  • Junchao Wu
  • Xin Wang
  • Yongbin Li
  • Mingjun Wang
  • Zhengguo Yang
  • Bing PengEmail author
  • Zongguang ZhouEmail author
Article

Abstract

Background

The aim of the present study was to compare elective transjugular intrahepatic portosystemic shunt (TIPS) and laparoscopic splenectomy (LS) plus preoperative endoscopic varices ligation (EVL) in their efficacy in preventing recurrent bleeding and improving the long-term liver function in patients with liver cirrhosis and portal hypertension.

Methods

Between January 2009 and March 2012, we enrolled 83 patients (55 with TIPS, defined as the TIPS group, and 28 with LS plus preoperative EVL, defined as the LS group) with portal hypertension and a history of gastroesophageal variceal bleeding resulting from liver cirrhosis. The clinical characteristics, perioperative outcomes, and follow-up were recorded.

Results

No significant differences were observed between the two treatment groups with respect to the patients’ characteristics and preoperative variables. Within 30 days after surgery, one patient in the TIPS group died of multiple organ dysfunction syndrome, whereas no patient in the LS group died. Complications occurred in 14 patients in the TIPS group, which included rebleeding, encephalopathy, ascites, bleeding from a pseudoaneurysm of the thoracoabdominal aorta, and pulmonary infection, compared with 5 patients in the LS group, which included pulmonary effusion, pancreatic leakage, and portal vein thrombosis. During a mean follow-up of 13.6 months in the TIPS group and 12.3 months in the LS group, the actuarial survival was 85.5 % in the TIPS group versus 100 % in the LS group. The long-term complications included rebleeding and encephalopathy in the TIPS group.

Conclusions

LS plus EVL was superior to TIPS in the prevention of gastroesophageal variceal rebleeding in cirrhotic patients. This treatment was associated with a low rate of portosystemic encephalopathy and improvements in the long-term liver function.

Keywords

Endoscopic varices ligation Laparoscopic splenectomy Liver cirrhosis Portal hypertension Recurrent variceal bleeding Transjugular intrahepatic portosystemic shunt 

Notes

Disclosures

Drs. Bing Peng, Zhong Wu, Jin Zhou, and Junchao Wu have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jin Zhou
    • 1
  • Zhong Wu
    • 2
  • Junchao Wu
    • 3
  • Xin Wang
    • 2
  • Yongbin Li
    • 2
  • Mingjun Wang
    • 2
  • Zhengguo Yang
    • 2
  • Bing Peng
    • 2
    Email author
  • Zongguang Zhou
    • 1
    Email author
  1. 1.Department of Gastrointestinal SurgeryWest China Hospital, Sichuan UniversityChengduChina
  2. 2.Department of Hepatopancreatobiliary SurgeryWest China Hospital, Sichuan UniversityChengduChina
  3. 3.Department of Gastroenterology and HepatologySichuan UniversityChengduChina

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