3:54 PM Abstract No. 323 Preoperative transjugular intrahepatic portosystemic shunt to improve subsequent surgical complications

Abstract

Abdominal and pelvic surgeries in cirrhotic patients with portal hypertension are associated with high rates of complications due to venous congestion. Preoperative portal decompression to treat complications of elevated portal pressure may be beneficial in reducing these complications. The aim of this study is to assess outcomes of cirrhotic patients undergoing abdominal and pelvic surgery after placement of TIPS for portal decompression. A single-institution retrospective review of patients undergoing TIPS for portal decompression prior to abdominal or pelvic surgery was performed, from 2009 to 2019. Pre and postprocedural analysis included model for end stage liver disease (MELD) score, Child-Pugh Score, and rate of perioperative complications including new or worsening ascites and encephalopathy, infection, gastrointestinal bleeding, renal failure, and mortality. Between 2009 and 2019, 11 patients at our institution underwent TIPS placement specifically for portal decompression prior to abdominal surgery. 4 patients underwent partial colonic resection for colonic malignancy, 4 underwent umbilical hernia repair (3 for Flood syndrome), 1 patient each had a hemorrhagic colorectal anastomosis resection, partial nephrectomy for renal cell carcinoma, and Whipple procedure for pancreatic cancer. The average portosystemic gradient reduction was from 17 ± 4 to 6 ± 2 and mean TIPS to surgery interval was 31 days (range, 2-72 days). Average preoperative MELD score was 13 ± 4 and distribution of Child Pugh Scores was A (27%), B (36%), C (36%). Postoperatively, 2 patients developed antibiotic requiring infections. 2 patients developed bleeding complications (defined as requiring >2 units packed red blood cells). 1 patient developed new encephalopathy requiring medical treatment. No patients developed new or worsening ascites or renal failure requiring dialysis. Thirty, 90, and 1 year mortality rates were 0%, 0%, and 23% respectively. Preoperative portal decompression with TIPS can allow patients who otherwise may not be surgical candidates to undergo abdominal and pelvic surgery with a low rate of serious perioperative morbidity and mortality.