Role Of Neo-Adjuvant TIPS In Child Pugh Class A And B Cirrhotic Patients Undergoing Elective Intra-Abdominal Surgery

Abstract

BACKGROUND: Portal hypertension is routinely diagnosed and managed among cirrhotic patients. While awaiting liver transplant a number of patients may require elective intra-abdominal surgery for alternative reasons. These patients are at increased risk of morbidity and mortality due to underlying portal hypertension which results in higher bleeding risk and poor wound healing.

AIM: To determine safety and efficacy of pre-operative prophylactic TIPSS in improving surgical outcomes.

METHODS: A retrospective chart review was performed for Child Pugh Class A or B patients who underwent prophylactic TIPSS procedure before elective intra-abdominal surgery at our institution over a span of 5 years.

RESULTS: A total of 9 patients satisfied the inclusion criteria. All underwent their respective surgical procedure within a mean of 2.5 months from the time of TIPSS placement. Average hospital stay post-surgery was 2.5 days and 30-day mortality was 0%. The surgery included- umbilical hernia repair with or without mesh (6/9), open nephrectomy (1/9), laparoscopic nephrectomy (1/9) and open cholecystectomy (1/9). There were no reported peri-operative complications including infection, bleeding or hepatic decompensation.

CONCLUSION: Preoperative portal decompression by using neo-adjuvant TIPSS is a safe and efficacious modality to de