Review: Surgical shunts and encephalopathy

Historically, surgical shunts have played an important role in the treatmen t of patients with portal hypertension associated with ascites and/or varic eal esophageal bleeding. Today, in the era of liver transplantation most pa tients with end-stage liver disease and concomitant portal hypertension and associated problems are best treated by liver grafting. The successful int roduction of transjugular intrahepatic portosystemic shunting (TIPS), perfo rmed by radiologists and gastroenterologists, provides a very effective alt ernative to surgical shunt procedures. One advantage of TIPS is that this p rocedure does not interfere with subsequent liver grafting. Today, surgical shunts have clearly lost ground to the less invasive TIPS procedure. Surgi cal shunts still maintain a role: as a salvage procedure in selected cases and in emergency situations. Surgical shunts are associated with a high rat e of encephalopathy. In most cases selective surgical shunts should be pref erred to nonselective surgical shunts. The role of partial surgical shunts versus selective surgical shunts remains to be determined. Hepatic encephal opathy is a common complication of all shunt procedures and is dependent on the shunt volume. Liver grafting is able to reverse encephalopathy because of a shunting procedure. In our institution, we prefer TIPS over surgical shunts as a bridging procedure before liver transplantation.