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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References
Loffroy R, Favelier S, Pottecher P, Estivalet L, Genson PY, Gehin S, et al. Transjugular intrahepatic portosystemic shunt for acute variceal gastrointestinal bleeding: Indications, techniques and outcomes. Diagnostic and interventional imaging. 2015;96(7–8):745–55.
de Goede B, Klitsie PJ, Lange JF, Metselaar HJ, Kazemier G. Morbidity and mortality related to non-hepatic surgery in patients with liver cirrhosis: a systematic review. Best practice & research Clinical gastroenterology. 2012;26(1):47–59.
Northup PG, Wanamaker RC, Lee VD, Adams RB, Berg CL. Model for End-Stage Liver Disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis. Annals of surgery. 2005;242(2):244–51.
De Stefano F, Garcia CR, Gupta M, Marti F, Turcios L, Dugan A, et al. Outcomes in patients with portal hypertension undergoing gastrointestinal surgery: A propensity score matched analysis from the NSQIP dataset. The American Journal of Surgery. 2018.
Azoulay D, Buabse F, Damiano I, Smail A, Ichai P, Dannaoui M, et al. Neoadjuvant transjugular intrahepatic portosystemic shunt: a solution for extrahepatic abdominal operation in cirrhotic patients with severe portal hypertension. Journal of the American College of Surgeons. 2001;193(1):46–51.
Fares N, Robic MA, Peron JM, Muscari F, Otal P, Suc B, et al. Transjugular intrahepatic portosystemic shunt placement before abdominal intervention in cirrhotic patients with portal hypertension: lessons from a pilot study. European journal of gastroenterology & hepatology. 2018;30(1):21–6.
Vinet E, Perreault P, Bouchard L, Bernard D, Wassef R, Richard C, et al. Transjugular intrahepatic portosystemic shunt before abdominal surgery in cirrhotic patients: a retrospective, comparative study. Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 2006;20(6):401–4.
Corey KE, Kaplan LM. Obesity and liver disease: the epidemic of the twenty-first century. Clinics in liver disease. 2014;18(1):1–18.
Kim JJ, Dasika NL, Yu E, Fontana RJ. Cirrhotic patients with a transjugular intrahepatic portosystemic shunt undergoing major extrahepatic surgery. Journal of clinical gastroenterology. 2009;43(6):574–9.
Wong RJ, Ahmed A. Obesity and non-alcoholic fatty liver disease: Disparate associations among Asian populations. World journal of hepatology. 2014;6(5):263–73.
O'Leary JG, Yachimski PS, Friedman LS. Surgery in the patient with liver disease. Clinics in liver disease. 2009;13(2):211–31.
Teh SH, Nagorney DM, Stevens SR, Offord KP, Therneau TM, Plevak DJ, et al. Risk Factors for Mortality After Surgery in Patients With Cirrhosis. Gastroenterology. 2007;132(4):1261–9.
Riggio O, Nardelli S, Moscucci F, Pasquale C, Ridola L, Merli M. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Clinics in liver disease. 2012;16(1):133–46.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery. 2004;240(2):205–13.
Smith MT, Rase B, Woods A, Trotter J, Gipson M, Kondo K, et al. Risk of hernia incarceration following transjugular intrahepatic portosystemic shunt placement. Journal of vascular and interventional radiology : JVIR. 2014;25(1):58–62.
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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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.
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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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DOI: https://doi.org/10.1007/s11605-019-04384-w