Preoperative transjugular intrahepatic portosystemic shunt (TIPS) for cirrhotic patients undergoing abdominal and pelvic surgeries

Abstract

Surgery for patients with cirrhosis is associated with increased morbidity and mortality. Perioperative complications including hemorrhage, wound dehiscence, and peritonitis result from underlying portal hypertension. Perioperative control of portal hypertension could decrease the risk of such complications. This study aimed to describe the authors' experience with the placement of transjugular intrahepatic portosystemic shunts (TIPS) in patients with cirrhosis to improve surgical outcomes. A retrospective chart review was performed for seven patients who underwent TIPS placement before elective abdominal or pelvic surgery at the University of Colorado Health Sciences Center from 1998 to 2006. The TIPS indication for each patient was to minimize perioperative complications. The seven patients in this study underwent their planned surgical procedure within a mean of 13 days from the time of TIPS placement. Two patients required a blood transfusion of two units or less. Three patients experienced a total of four postoperative complications including wound infection, peritonitis, pneumonia, and new ascites. One patient died of liver failure 14 months after surgery. The preparation of patients with cirrhosis and portal hypertension for elective surgery using preoperative portal decompression may decrease the risk of perioperative morbidity and mortality.