Transjugular Intrahepatic Portosystemic Shunt before Abdominal Surgery in Cirrhotic Patients: A Retrospective, Comparative Study
Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal hypertension and liver insufficiency. Therefore, preoperative portal decompression is a logical approach to facilitate abdominal surgery and hopefully to improve postoperative survival. The present study...
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| Format: | Article |
| Language: | English |
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Wiley
2006-01-01
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| Series: | Canadian Journal of Gastroenterology |
| Online Access: | http://dx.doi.org/10.1155/2006/245082 |
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| author | Evelyne Vinet Pierre Perreault Louis Bouchard Denis Bernard Ramses Wassef Carole Richard Richard Létourneau Gilles Pomier-Layrargues |
| author_facet | Evelyne Vinet Pierre Perreault Louis Bouchard Denis Bernard Ramses Wassef Carole Richard Richard Létourneau Gilles Pomier-Layrargues |
| author_sort | Evelyne Vinet |
| collection | DOAJ |
| description | Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal hypertension and liver insufficiency. Therefore, preoperative portal decompression is a logical approach to facilitate abdominal surgery and hopefully to improve postoperative survival. The present study evaluated the clinical outcomes of 18 patients (mean age 58 years) with cirrhosis (seven alcoholics and 11 nonalcoholics) who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement before antrectomy (n=5), colectomy (n=10), small-bowel resection (n=1), pancreatectomy (n=1) and nephrectomy (n=1). TIPS was performed a mean (± SD) of 72±21 days before surgery and induced a marked mean decrease in portohepatic gradient from 21.4±3.9 mmHg to 8.4±3.4 mmHg. Cirrhotic patients (n=17) who underwent elective abdominal surgery without preoperative TIPS placement were used as the control group. Both groups were matched for age, etiology of cirrhosis, indications for surgery, type of surgery and coagulation parameters. The mean Pugh score was significantly higher in the TIPS group (7.7 versus 6.2). No significant differences were observed for operative blood loss, postoperative complications, duration of hospitalization and one-month (83% versus 88%) or one-year (54% versus 63%) cumulative survival rate. Analysis using the Cox proportional hazards model showed that neither TIPS placement nor preoperative Pugh score were independent predictors for survival. The present study suggests that preoperative TIPS placement does not improve postoperative evolution after abdominal surgery in cirrhotic patients with good or moderately impaired liver function. |
| format | Article |
| id | doaj-art-fe562521bfd3401ea07d0eae050d4498 |
| institution | OA Journals |
| issn | 0835-7900 |
| language | English |
| publishDate | 2006-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology |
| spelling | doaj-art-fe562521bfd3401ea07d0eae050d44982025-08-20T02:22:33ZengWileyCanadian Journal of Gastroenterology0835-79002006-01-0120640140410.1155/2006/245082Transjugular Intrahepatic Portosystemic Shunt before Abdominal Surgery in Cirrhotic Patients: A Retrospective, Comparative StudyEvelyne Vinet0Pierre Perreault1Louis Bouchard2Denis Bernard3Ramses Wassef4Carole Richard5Richard Létourneau6Gilles Pomier-Layrargues7Liver Unit, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, CanadaRadiology Department, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, CanadaRadiology Department, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, CanadaDigestive Surgery Unit, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, CanadaDigestive Surgery Unit, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, CanadaDigestive Surgery Unit, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, CanadaHepatobiliary Surgery Unit, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, CanadaLiver Unit, Hopital Saint-Luc, Centre Hospitalier de l’Universite de Montreal, Montreal, Quebec, CanadaSurgery in cirrhotic patients is associated with high morbidity and mortality related to portal hypertension and liver insufficiency. Therefore, preoperative portal decompression is a logical approach to facilitate abdominal surgery and hopefully to improve postoperative survival. The present study evaluated the clinical outcomes of 18 patients (mean age 58 years) with cirrhosis (seven alcoholics and 11 nonalcoholics) who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement before antrectomy (n=5), colectomy (n=10), small-bowel resection (n=1), pancreatectomy (n=1) and nephrectomy (n=1). TIPS was performed a mean (± SD) of 72±21 days before surgery and induced a marked mean decrease in portohepatic gradient from 21.4±3.9 mmHg to 8.4±3.4 mmHg. Cirrhotic patients (n=17) who underwent elective abdominal surgery without preoperative TIPS placement were used as the control group. Both groups were matched for age, etiology of cirrhosis, indications for surgery, type of surgery and coagulation parameters. The mean Pugh score was significantly higher in the TIPS group (7.7 versus 6.2). No significant differences were observed for operative blood loss, postoperative complications, duration of hospitalization and one-month (83% versus 88%) or one-year (54% versus 63%) cumulative survival rate. Analysis using the Cox proportional hazards model showed that neither TIPS placement nor preoperative Pugh score were independent predictors for survival. The present study suggests that preoperative TIPS placement does not improve postoperative evolution after abdominal surgery in cirrhotic patients with good or moderately impaired liver function.http://dx.doi.org/10.1155/2006/245082 |
| spellingShingle | Evelyne Vinet Pierre Perreault Louis Bouchard Denis Bernard Ramses Wassef Carole Richard Richard Létourneau Gilles Pomier-Layrargues Transjugular Intrahepatic Portosystemic Shunt before Abdominal Surgery in Cirrhotic Patients: A Retrospective, Comparative Study Canadian Journal of Gastroenterology |
| title | Transjugular Intrahepatic Portosystemic Shunt before Abdominal Surgery in Cirrhotic Patients: A Retrospective, Comparative Study |
| title_full | Transjugular Intrahepatic Portosystemic Shunt before Abdominal Surgery in Cirrhotic Patients: A Retrospective, Comparative Study |
| title_fullStr | Transjugular Intrahepatic Portosystemic Shunt before Abdominal Surgery in Cirrhotic Patients: A Retrospective, Comparative Study |
| title_full_unstemmed | Transjugular Intrahepatic Portosystemic Shunt before Abdominal Surgery in Cirrhotic Patients: A Retrospective, Comparative Study |
| title_short | Transjugular Intrahepatic Portosystemic Shunt before Abdominal Surgery in Cirrhotic Patients: A Retrospective, Comparative Study |
| title_sort | transjugular intrahepatic portosystemic shunt before abdominal surgery in cirrhotic patients a retrospective comparative study |
| url | http://dx.doi.org/10.1155/2006/245082 |
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