A team from the University of Washington School of Medicine, Seattle, USA, compared the use of transjugular intrahepatic portasystemic shunt (TIPS) with surgical shunt, in good-risk patients undergoing portal decompression for variceal bleeding.
40 cirrhotic patients (Child-Pugh class A or B) with at least one prior episode of bleeding from portal hypertension underwent portal decompression by either angiographic (TIPS) or surgical (portacaval, distal splenorenal) shunt.
The team measured 30-day and long-term mortality. In addition, they assessed postintervention diagnostic procedures (endoscopic, ultrasonographic, and angiographic studies), hospital readmission, variceal rebleeding episodes, blood transfusions, shunt revisions, and hospital and professional charges.
Cirrhotic patients undergoing TIPS (n = 20) or surgical shunt (n = 20) were followed up for 385 and 456 patient-months, respectively.
|30-day mortality rates following shunt procedure:|
TIPS - 20%
Surgical - 0%
|Archives of Surgery|
The researchers found that 30-day mortality was greater following TIPS, compared with surgical shunt (20 per cent vs. 0 per cent); long-term mortality did not differ.
Significantly more rebleeding episodes; rehospitalizations; diagnostic studies of all types; shunt revisions; and hospital, professional, and total charges occurred following TIPS, compared with surgical shunt.
Dr W. Scott Helton said on behalf of the group, "Operative portal decompression is more effective, more durable, and less costly than TIPS in cirrhotic patients with variceal bleeding."
"Good-risk patients with portal hypertensive bleeding should be referred for surgical shunt," he concluded.