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Transjugular intrahepatic portosystemic shunt versus distal splenorenal shunt--a comparative study
J S Khaitiyar1, S K Luthra, N Prasad
1Department of Gastroenterology, Suchitra Memorial Hospital, New Delhi, India.
Insights
Distal splenorenal shunt surgery is more effective than transjugular intrahepatic portosystemic shunt for controlling recurrent variceal bleeding in cirrhosis patients. It shows lower recurrence and complication rates, with similar survival outcomes.
Area of Science:
- Hepatology
- Surgical Gastroenterology
- Interventional Radiology
Background:
- Recurrent variceal bleeding in hepatic cirrhosis lacks a consensus surgical approach.
- Transjugular intrahepatic portosystemic shunt (TIPS) and distal splenorenal shunt (DSRS) are common interventions.
- Comparative efficacy of TIPS vs. DSRS for variceal bleeding is under investigation.
Purpose of the Study:
- To compare the efficacy of TIPS and DSRS in managing recurrent variceal bleeding.
- To evaluate complications and survival rates associated with TIPS and DSRS.
- To determine the optimal surgical strategy for cirrhotic patients with variceal bleeding.
Main Methods:
- A cohort of 67 patients with alcoholic liver cirrhosis (Child-Pugh A/B) and recurrent variceal bleeding were studied.
- Patients underwent either TIPS (n=35) or DSRS (n=32) and were followed for a mean of 887 days.
- Outcomes assessed included survival, bleeding recurrence, encephalopathy, ascites, and shunt blockade.
Main Results:
- DSRS showed significantly lower rates of bleeding recurrence (6.25% vs 25.71%), encephalopathy (18.75% vs 42.86%), and shunt blockade (6.25% vs 68.57%) compared to TIPS.
- Fasting blood ammonia levels were lower with DSRS (56.70 vs 61.70 mumol/L).
- Ascites rates were higher with DSRS (40.63% vs 11.43%), with no significant difference in midterm survival (81.25% vs 80.00%).
Conclusions:
- Distal splenorenal shunt operation is a superior therapeutic option for recurrent variceal bleeding in hepatic cirrhosis.
- DSRS offers better control of bleeding and associated complications compared to TIPS.
- Both procedures effectively managed renal failure and hypersplenism, with comparable survival.
Background/Aims:
No general consensus exists regarding the proper surgical management of recurrent variceal bleeding due to hepatic cirrhosis. Transjugular intrahepatic portosystemic shunt and distal splenorenal shunt are increasingly being performed in the management of these patients. The present study was undertaken to compare the efficacy, complications and survival rate of these two procedures.
Methodology:
Sixty-seven patients with alcoholic liver cirrhosis of Child-Pugh's class A (n = 22) and class B (n = 45) with recurrent variceal bleeding not controlled by conservative means underwent either transjugular intrahepatic portosystemic shunt placement (n = 35) or a distal splenorenal shunt operation (n = 32). These patients were followed for a mean of 887 +/- 189 days. Both groups were compared with respect to the rates of survival, recurrence of gastrointestinal bleeding, encephalopathy, ascitis, shunt blockade and other relevant biochemical parameters.
Results:
Patients who underwent a distal splenorenal shunt operation had lower rates of recurrence of gastrointestinal bleeding (6.25% vs. 25.71%), encephalopathy (18.75% vs. 42.86%) shunt blockade (6.25% vs. 68.57%) and lower mean fasting blood ammonia levels (56.70 +/- 7.10 mumol/L vs. 61.70 +/- 5.70 mumol/L). However the rate of ascitis was higher amongst these patients (40.63% vs. 11.43%). There was no significant difference in the midterm survival rates between these groups (81.25% vs. 80.00%). Both procedures were effective in controlling functional renal failure, splenomegaly and features of hypersplenism.
Conclusions:
Distal splenorenal shunt operation is a better therapeutic option than transjugular intrahepatic portosystemic shunt placement for control of recurrent variceal bleeding due to hepatic cirrhosis.