Transjugular Intrahepatic Portosystemic Shunt Before Extrahepatic Abdominal Surgery: A Systematic Review and Novel...

Area of Science:

• Hepatology
• Interventional Radiology
• Surgical Oncology

Background:

• Patients with cirrhosis and portal hypertension face significant risks during extrahepatic abdominal operations.
• The utility of transjugular intrahepatic portosystemic shunts (TIPS) in improving surgical outcomes, particularly in emergencies, is not well-established.

Purpose of the Study:

• To systematically review the role of preoperative, perioperative, and emergent TIPS in patients with cirrhosis undergoing extrahepatic abdominal operations.
• To evaluate the impact of TIPS on surgical outcomes, mortality, and complications in this patient population.

Main Methods:

• Systematic review of 14 studies (2000-2025) involving 241 patients undergoing non-transplant abdominal operations with TIPS.
• Data extraction included patient characteristics, timing of TIPS, mortality, complications, and statistical methods.

Main Results:

• Elective preoperative TIPS (2-4 weeks prior) in Child-Pugh A-B patients (MELD <15) improved ascites control and feasibility, with 80-90% proceeding to surgery and ≤10% 30-90 day mortality, but no clear survival benefit over controls.
• Perioperative and emergent TIPS were used in high-risk patients, with high mortality but reduced bleeding, enabling complex surgeries.
• A unique case demonstrated salvage TIPS after colectomy for diverticulitis, facilitating abdominal closure in severe portal hypertension.

Conclusions:

• Transjugular intrahepatic portosystemic shunts (TIPS) are a feasible adjunct for carefully selected cirrhotic patients to optimize operative candidacy.
• TIPS may play a crucial role in salvage settings within acute care surgery when standard hemostasis fails.