Journal of Clinical Hepatology
A transjugular intrahepatic portosystemic shunt, or TIPS, creates a channel inside the liver to reduce high pressure in the portal circulation. Performing conventional TIPS can be extremely difficult when the portal vein is extensively blocked, narrowed or replaced by a network of collateral vessels.
Researchers evaluated a surgery-assisted TIPS technique in 36 patients with portal hypertension and complex portal vein thrombosis, including cavernous transformation of the portal vein. During the procedure, surgeons exposed and accessed a mesenteric vein through open or laparoscopic surgery. This provided a route that helped interventional specialists locate and reconstruct the portal circulation before creating the shunt.
The procedure was technically successful in 34 of the 36 patients, giving a success rate of 94.4%. Portal pressure decreased significantly after shunt creation, and 76.5% of successfully treated patients achieved a reduction of at least 50%.
All successfully placed shunts remained open when assessed by imaging within one week. Six patients experienced perioperative complications: three had thoracic or abdominal bleeding, two developed an intraoperative abnormal heart rhythm and one had a surgical-site infection.
These early results suggest that surgical assistance can provide an alternative route when conventional TIPS is technically difficult or unlikely to succeed.
Complex portal vein thrombosis can make standard TIPS impossible, leaving patients with limited options for controlling variceal bleeding, refractory ascites and other complications of portal hypertension.
By combining surgical access with interventional radiology, surgery-assisted TIPS may allow portal decompression in anatomically challenging cases, including patients with cavernous transformation. The high technical success rate provides encouraging evidence that this approach is feasible in an experienced multidisciplinary centre.
However, the study included only 36 patients from one hospital, had no conventional-treatment comparison group and reported shunt patency only during the first postoperative week. Longer follow-up is needed to assess rethrombosis, hepatic encephalopathy, recurrent bleeding, survival and long-term shunt function.
Objective: To investigate the feasibility, safety, and efficacy of surgery-assisted transjugular intrahepatic portosystemic shunt...
