TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT - REQUIEM FOR THE SURGICAL PORTOSYSTEMIC SHUNT

Is transjugular intrahepatic portosystemic shunt (TIPS) preferable to a surgical shunting procedure in patients who are expected to benefit from a portal-systemic shunt? Since randomized trials comparing these procedures have not yet been reported, we attempted to define the pres ent best therapeutic strategy by reviewing both the recent literature on TIPS and surgical shunting and our first experience with TIPS. The results suggest that TIPS is just as effective as surgical shunting bu t is associated with a lower morbidity and mortality. Procedure relate d deaths seem rare. In our series of 16 patients there was one death w ithin 30 days. Seven early complications including stent dislodgement, early occlusion, encephalopathy and haemolysis were noted. The incide nce of long-term complications, especially encephalopathy and shunt oc clusion, seems comparable for both shunting procedures. Major advantag es of TIPS are its therapeutic efficacy in patients with ascites and t he fact that the technical difficulties of performing liver transplant ation are not increased. We conclude that TIPS, performed by an experi enced team, is at present the procedure of choice in patients who are candidates for a portal-systemic shunt, especially in patients in whom liver transplantation is a future option. Surgical shunts can be rese rved for patients in whom TIPS is not feasible or has failed.