The role of transjugular intrahepatic portosystemic shunt prior to abdominal tumoral surgery in cirrhotic patients with portal hypertension

Surgery in the Patient with Liver Disease

“…Postoperative morbidity in such patients, and possibly in patients with Child class B and C cirrhosis, may be reduced by preoperative placement of a transjugular intrahepatic portosystemic shunt (TIPS) (11)(12)(13).…”

Transjugular Intrahepatic Portosystemic Shunt prior to Cardiac Surgery with Cardiopulmonary Bypass in Patients with Cirrhosis and Portal Hypertension

“…The clinical utility of preoperative TIPS placement in patients with cirrhosis and portal hypertension prior to major abdominal surgeries has been known. 7,8 To the best of our knowledge, there is only one report in the English literature, mentioning the need for preoperative TIPS placement prior to a cardiac surgery in one patient, but the clinical outcome is not reported in detail. 5 We performed TIPS procedure in two patients prior to cardiac surgery with the use of cardiopulmonary bypass in order to reduce the increased risks associated with portal hypertension.…”

“…1,4 Reports indicate that decompressing portosystemic collaterals at the operative site and gastrointestinal tract with TIPS reduces the bleeding complications. 7,8 Similarly, in cardiac surgeries, portosystemic collaterals in the mediastinum, pericardium, and thorax wall may be responsible for increased operative site bleeding. In addition to postoperative stress ulcers and haemorrhagic gastritis, gastro-oesophageal variceal bleeding remains as a risk in patients with cirrhosis and portal hypertension after cardiac surgery.…”

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

“…It has become widely used to manage complications of portal hypertension such as refractory esophageal bleeding, refractory ascites, and hepatorenal syndrome. Placement of TIPS also has been reported for a small number of patients with cirrhosis and portal hypertension undergoing abdominal surgery to prevent complications [13][14][15][16]. We have had success with the use of TIPS for this indication and report our experience.…”