Outcomes of surgical shunts and transjugular intrahepatic portasystemic stent shunts for complicated portal hypertension

Abstract

Surgical shunting achieved better results than TIPSS in patients with complicated portal hypertension and low MELD scores.

Outcomes of parenchyma-preserving hepatectomy and right hepatectomy for solitary small colorectal liver metastasis: A LiverMetSurvey study

“…The propensity score method enables us to obtain 2 groups that are well balanced for prognostic factors. 25,26 However, including posttreatment variables as factors to calculate propensity scores is not recommended. 27 Therefore, applying propensity score methods to match the pathologic tumor size and postoperative chemotherapy between the 2 groups was not appropriate.…”

KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications

“…Those who undergo TIPS before liver transplantation show a lower mortality rate than those who do not receive TIPS (adjusted hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.90-0.99) [ 133 ]. A retrospective study has suggested that surgical shunts are more effective for refractory ascites than TIPS [ 134 ], but prospective comparison studies are needed. Cirrhotic patients usually have a high left-ventricular ejection fraction of >70-75% due to pathophysiological changes.…”

Update on Shunt Surgery

“…TIPS supporters criticized the fact that most of these trials used bare-metal TIPS rather than the PTFE-covered TIPS now in use. Hosokawa et al [20] included PTFE-covered TIPS in their study and also found better results with surgical shunts. Most studies evaluating PTFE-covered TIPS are retrospective, case series only, or have poor follow-up rates [40][41][42][43].…”

“…Surgical shunts perform better in terms of shunt patency, long-term survival, and economic aspects [1]. One significant objection in most studies comparing TIPS and surgical shunts is the use of uncovered stents, but even when polytetrafluoroethylene (PTFE)-covered stents are used, the surgical shunt shows better results [20]. The correct therapy algorithm for variceal decompression, taking into account liver function, rebleeding frequency, long-term outcome, graft patency, and cost-effectiveness, should be chosen by an interdisciplinary team with experience in the therapy of PH.…”