TIPSS - TECHNICAL AND CLINICAL-RESULTS AF TER 4 YEARS (TRANSJUGULAR-PORTOSYSTEMIC-STENT-SHUNT)

Purpose: Retrospective analysis of the technical and clinical results after transjugular portosystemic stent shunt (TIPSS) procedure. Method : Between 1992 and 1996 we tried to establish a TIPSS in 90 patients. The indications were: recurrent variceal haemorrhage (n=74), refractor y ascites (n=12), hepatorenal syndrome (HRS) (n=4). Due to advanced li ver cirrhosis 16 patients suffered of severe renal dysfunction (HRS). 57 patients had ascites. Results: TIPSS implantation was technically s uccessful in 96.7% (1992-1994: 5,1%, 1995-1996: 100%) of the patients. Complications occurred in 14.9% (1992-1994: 25.6%, 1995-1996: 6.3%). TIPSS-associated mortality was 2.3% (1992-1994: 5.1%, 1995-1996: 0%). 76.1% of the patients required reinterventions. 85.3% of reinterventio ns were necessary in the first year after TIPSS placement. The surviva l rate without reintervention was 28%, 21% and 9% for Child A, B, and C patients, respectively. Recurrent variceal haemorrhage occurred in 1 2.7%. De novo hepatic encephalopathy developed in 13.8%. Ascites impro ved in 79.2% and renal function in 75% of the patients. Conclusion: TI PSS is an effective method to treat recurrent variceal haemorrhage, re fractory ascites and HRS. Complication and mortality rate depend on th e investigator's experience and on the technique used.