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

Patients with cirrhosis undergoing extrahepatic abdominal operations face high morbidity and mortality from portal hypertension. The role of transjugular intrahepatic portosystemic shunts (TIPS) in optimizing surgical outcomes remains uncertain, particularly in emergent settings. We present a case and systematic review of studies from 2000-2025 evaluating preoperative, perioperative, and emergent TIPS in patients undergoing extrahepatic abdominal operations. Data on patient characteristics, timing, mortality, complications, and statistical methods were extracted.Fourteen studies were included, encompassing 241 patients who underwent TIPS specifically in the context of non-transplant abdominal operation. Across elective preoperative cohorts, TIPS was mostly performed 2-4 weeks before operation in Child-Pugh A-B patients with MELD <15 which was reported to improve ascites control and operative feasibility, with 80-90% of patients proceeding to the planned operation and 30 to 90-day mortality generally ≤10%, without a clear survival advantage compared with non-TIPS controls. Perioperative and emergent TIPS were reserved for decompensated or high-risk patients, in whom overall mortality remained high but portal decompression reduced bleeding and allowed otherwise prohibitive operations to proceed. This case describes unique TIPS timing, not previously described, after initial colectomy for perforated diverticulitis, enabling reduced bleeding and abdominal closure in the setting of severe portal hypertension. Taken together, available evidence supports TIPS as a feasible adjunct to optimize operative candidacy in carefully selected cirrhotic patients. This highlights a potential role for salvage TIPS in acute care surgery when standard hemostatic techniques fail.