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Canadian Journal of Gastroenterology
Volume 20, Issue 6, Pages 401-404
http://dx.doi.org/10.1155/2006/245082
Original Article

Transjugular Intrahepatic Portosystemic Shunt before Abdominal Surgery in Cirrhotic Patients: A Retrospective, Comparative Study

Evelyne Vinet,1 Pierre Perreault,2 Louis Bouchard,2 Denis Bernard,3 Ramses Wassef,3 Carole Richard,3 Richard Létourneau,4 and Gilles Pomier-Layrargues1

1Liver Unit, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
2Radiology Department, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
3Digestive Surgery Unit, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada
4Hepatobiliary Surgery Unit, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, Canada

Received 24 January 2006; Accepted 24 January 2006

Copyright © 2006 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal hypertension and liver insufficiency. Therefore, preoperative portal decompression is a logical approach to facilitate abdominal surgery and hopefully to improve postoperative survival. The present study evaluated the clinical outcomes of 18 patients (mean age 58 years) with cirrhosis (seven alcoholics and 11 nonalcoholics) who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement before antrectomy (n=5), colectomy (n=10), small-bowel resection (n=1), pancreatectomy (n=1) and nephrectomy (n=1). TIPS was performed a mean (± SD) of 72±21 days before surgery and induced a marked mean decrease in portohepatic gradient from 21.4±3.9 mmHg to 8.4±3.4 mmHg. Cirrhotic patients (n=17) who underwent elective abdominal surgery without preoperative TIPS placement were used as the control group. Both groups were matched for age, etiology of cirrhosis, indications for surgery, type of surgery and coagulation parameters. The mean Pugh score was significantly higher in the TIPS group (7.7 versus 6.2). No significant differences were observed for operative blood loss, postoperative complications, duration of hospitalization and one-month (83% versus 88%) or one-year (54% versus 63%) cumulative survival rate. Analysis using the Cox proportional hazards model showed that neither TIPS placement nor preoperative Pugh score were independent predictors for survival. The present study suggests that preoperative TIPS placement does not improve postoperative evolution after abdominal surgery in cirrhotic patients with good or moderately impaired liver function.