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Journal of Gastrointestinal Surgery

, Volume 23, Issue 12, pp 2383–2390 | Cite as

Original Study: Transjugular Intrahepatic Portosystemic Shunt as a Bridge to Abdominal Surgery in Cirrhotic Patients

  • N. Tabchouri
  • L. Barbier
  • B. Menahem
  • J.-M. Perarnau
  • F. Muscari
  • N. Fares
  • L. D’Alteroche
  • P.-J. Valette
  • J. Dumortier
  • A. Alves
  • J. Lubrano
  • C. Bureau
  • Ephrem SalaméEmail author
Original Article

Abstract

Background

Transjugular intrahepatic portosystemic shunt (TIPS) has been suggested to reduce portal hypertension-associated complications in cirrhotic patients undergoing abdominal surgery. The aim of this study was to compare postoperative outcome in cirrhotic patients with and without specific preoperative TIPS placement, following elective extrahepatic abdominal surgery.

Methods

Patients were retrospectively included from 2005 to 2016 in four centers. Patients who underwent preoperative TIPS (n = 66) were compared to cirrhotic control patients without TIPS (n = 68). Postoperative outcome was analyzed using propensity score with inverse probability of treatment weighting analysis.

Results

Overall, colorectal surgery accounted for 54% of all surgical procedure. TIPS patients had a higher initial Child-Pugh score (6[5–12] vs. 6[5–9], p = 0.043) and received more beta-blockers (65% vs. 22%, p < 0.001). In TIPS group, 56 (85%) patients managed to undergo planned surgery. Preoperative TIPS was associated with less postoperative ascites (hazard ratio = 0.330 [0.140–0.780]). Severe postoperative complications (Clavien-Dindo > 2) and 90-day mortality were similar between TIPS and no-TIPS groups (18% vs. 23%, p = 0.392, and 7.5% vs. 7.8%, p = 0.644, respectively).

Conclusions

Preoperative TIPS placement yielded an 85% operability rate with satisfying postoperative outcomes. No significant differences were found between TIPS and no-TIPS groups in terms of severe postoperative complications and mortality, although TIPS patients probably had worse initial portal hypertension.

Keywords

Cirrhosis Abdominal surgery Colorectal surgery Preoperative TIPS Postoperative outcome 

Notes

Authorship

NT collected the data, did the statistical analysis, and wrote the manuscript.

LB supervised statistical analysis and wrote the manuscript.

BM, FM, NF, LdA, PJV, JD, AA, and JL collected the data and corrected the manuscript.

CB and ES designed the study and corrected the manuscript.

Compliance with Ethical Standards

This retrospective study was approved by the regional ethics comity and was declared to the French Data Protection Authority.

Supplementary material

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • N. Tabchouri
    • 1
    • 2
  • L. Barbier
    • 1
    • 2
  • B. Menahem
    • 3
  • J.-M. Perarnau
    • 4
  • F. Muscari
    • 5
  • N. Fares
    • 6
  • L. D’Alteroche
    • 4
  • P.-J. Valette
    • 7
  • J. Dumortier
    • 7
  • A. Alves
    • 3
  • J. Lubrano
    • 3
  • C. Bureau
    • 6
  • Ephrem Salamé
    • 1
    • 2
    Email author
  1. 1.Department of Digestive Surgery, Hepatobiliary Surgery and Liver TransplantationUniversity Hospital of Tours, CHU ToursToursFrance
  2. 2.FHU SupportToursFrance
  3. 3.Department of Digestive SurgeryUniversity Hospital of CaenCaen CedexFrance
  4. 4.Department of HepatologyUniversity Hospital of Tours, CHU ToursToursFrance
  5. 5.Department of SurgeryHôpital RangueilToulouseFrance
  6. 6.Department of Hepatology and Gastroenterology, Purpan HospitalUniversity Hospital of ToulouseToulouse Cedex 9France
  7. 7.Department of Digestive Diseases, Hospices Civils de Lyon, Hôpital Edouard HerriotUniversité Claude Bernard Lyon 1LyonFrance

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