Review: surgical shunts and encephalopathy

Area of Science:

• Hepatology
• Interventional Radiology
• Surgical Gastroenterology

Background:

• Surgical shunts historically treated portal hypertension, ascites, and variceal bleeding.
• Liver transplantation is now the primary treatment for end-stage liver disease with portal hypertension.
• Transjugular intrahepatic portosystemic shunting (TIPS) has emerged as a less invasive alternative.

Purpose of the Study:

• To compare the efficacy and role of TIPS versus surgical shunts in managing portal hypertension.
• To evaluate the impact of these procedures on liver transplantation and hepatic encephalopathy.

Main Methods:

• Review of historical and current treatment paradigms for portal hypertension.
• Comparison of transjugular intrahepatic portosystemic shunting (TIPS) with various surgical shunt procedures.
• Analysis of complication rates, particularly hepatic encephalopathy, and impact on liver grafting.

Main Results:

• Transjugular intrahepatic portosystemic shunting (TIPS) is highly effective and does not preclude liver transplantation.
• Surgical shunts are largely replaced by TIPS but retain roles in salvage and emergency cases.
• Surgical shunts are associated with a high incidence of hepatic encephalopathy, which can be reversed by liver grafting.

Conclusions:

• Transjugular intrahepatic portosystemic shunting (TIPS) is the preferred method for managing portal hypertension, especially as a bridge to liver transplantation.
• Selective surgical shunts may be preferred over nonselective ones when surgery is necessary.
• Hepatic encephalopathy is a significant complication of shunting procedures, influenced by shunt volume.