Intrahepatic portosystemic shunt in treatment of complications of portal hypertension.
BACKGROUND
The aim of the paper is to present the role of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension complications such as variceal bleeding and persistent ascites.


METHODS
Between June 1992 and December 2000, 56 patients with portal hypertension developed in the course of hepatic cirrhosis were qualified for TIPS. The indications for TIPS included esophageal variceal bleeding, recurrent despite endoscopic treatment (N-40), active esophageal variceal hemorrhages in which traditional methods used to stop the bleeding proved ineffective (N-8) and ascites failing to respond to high doses of diuretic agents (N-8). The studied group consisted of 30 females and 26 male patients aged from 17 to 68 (mean age 52 yrs). According to Child-Pugh surgical risk classification, 26 patients belonged to group B, and 30 to group C.


RESULTS
In 50 patients (83.5%) an intrahepatic shunt was formed and the stent(s) implanted. In 42 cases (75%), long-lasting patency of the shunt was obtained and esophageal variceal bleeding was stopped. Active esophageal variceal hemorrhages were stopped in all the cases. The remission of massive ascites and hepatorenal syndrome was obtained in 7 out of 8 patients.


CONCLUSIONS
TIPS is a non-surgical method relieving portal hypertension in patients with variceal hemorrhages recurrent despite endoscopic treatment. Very good results were also obtained in the cases with active variceal hemorrhages. TIPS has proved to be an effective method of treatment in the patients with massive ascites and hepatorenal syndrome.
Wróblewski
T
T
Department and Clinic of General and Liver Surgery, Medical University, Banacha 1a, 02-097 Warsaw, Poland.
Rowiński
O
O
Pawlak
J
J
Małkowski
P
P
Ziarkiewicz-Wróblewska
B
B
Michałowicz
B
B
Zurakowski
J
J
Krawczyk
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001201:Ascites; D005260:Female; D006530:Hepatorenal Syndrome / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical