Cirrhosis surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Sudarshana Datta, MD [3]

Overview

Patients with decompensated liver cirrhosis are usually candidates for liver transplantation. Liver transplantation may be carried out based on MELD score and assessment of the patient’s quality of life, absence of contraindications and disease severity. In cases where transplantation is contraindicated, a patient may undergo the TIPS procedure. A transjugular intrahepatic portosystemic shunt, also TIPS, is an artificial channel in the liver from the portal vein to a hepatic vein, created via the jugular vein. The main purpose of the TIPS procedure is to decompress the portal vein which would in turn help to prevent rebleeding from varices, and also prevent ascites formation. TIPS is used to treat portal hypertension which is often due to cirrhosis.

Surgery

Transplantation

Prevalence
Symptoms After Surgery
Survival

TIPS (Transjugular Intrahepatic Portosystemic Shunt)

Indications
Contraindications
Survival
Complications
  • Complications of TIPS include puncture and dilation of the portal vein, hematoma at the puncture site and thrombosis of the stent that is placed in the hepatic vein during the procedure.[41]
  • It is more difficult to perform liver transplantation after a patient has already undergone the TIPS procedure. Inserting a shunt into the liver needs to be exceedingly precise in patients that have the possibility of obtaining a new liver. In transplant cases, patient and graft survival is worse in individuals that previously had a shunt placed in the hepatic vein.[40]
Drawbacks

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References

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