Perioperative Support of Portosystemic Shunting Interventions in Complicated Portal Hypertension due to Liver Cirrhosis

Abstract

Introduction. Portosystemic shunting interventions in the treatment of life-threatening complications of portal hypertension allow to avoid a patient’s death but they decrease the portal blood perfusion which may lead to fatal hepatic failure. The adapting portal decompression (APD) using selective vasoconstrictors preoperatively is reasonable to prevent this complication. Methods. 103 patients had undergone transjugular intrahepatic portosystemic shunt (TIPS) placement and divided on two comparable groups. 52 patients of I group who received a common standard of preoperative treatment were compared with 60 patients of II group who had pre-TIPS APD (octreotide 300 mcg subcutaneously 2 times a day during 3–5 wk) in addition of standard therapy. Postoperative complications, 6-week and 1-year mortality rate and cumulative survival were comparably evaluated. Results. Intraoperative manometry revealed a decrease of portal pressure in the group of patients who received pre-TIPS APD (II group) comparably to patients of I group (р < 0.05). As result the clinical and laboratory improvement in II group was found. 6-week mortality in I group was 1.9 % (1 patient after increasing of incidence of hepatorenal syndrome). At II group was no mortality. In 1-year period after TIPS 15 patients (28.8 %) of I group and 8 (13.3 %) of II group died. Conclusion. It’s reasonable to make the pre-TIPS APD for prevention of hepatic failure as a result of decreasing of portal blood perfusion. These findings suggest the need for selective vasoconstrictor octreotide use.