The role of transjugular intrahepatic portosystemic shunt prior to abdominal tumoral surgery in cirrhotic patients with portal hypertension.
BACKGROUND
Major abdominal surgery can be contraindicated in some cirrhotic patients because of severe portal hypertension. The present study reports our experience of three patients with abdominal tumours prepared for surgery by transjugular intrahepatic portosystemic shunts (TIPS) in order to reduce portal hypertension and the risk of intraoperative bleeding.


METHODS
Three patients with cirrhosis and portal hypertension diagnosed with a right colon carcinoma, an adenocarcinoma of pancreas and a gastric and sigmoid synchronic tumours in the same patient. Because portal hypertension was the leading cause of surgical contraindication, neoadjuvant TIPS placement was proposed before surgery.


RESULTS
TIPS placement was performed without intra-procedure complications. An average reduction of 18 mmHg was achieved in portosystemic gradients. The planned operations were performed with a delay of 14-45 days after TIPS without intraoperative bleeding. Complications occurred in one patient without operative mortality.


CONCLUSIONS
TIPS placement allows a pre-operative portal decompression in cirrhotic patients with portal hypertension and abdominal tumours that require surgical treatment. This procedure reduces the risk of bleeding by reducing the portosystemic gradient and the varices around the tumoral area. This procedure is less invasive than conventional shunt surgery, but it is not free of complications and should be performed by experienced interventional radiologists on selected patients. This is still an experimental indication of TIPS which efficacy must be confirmed in larger series.
Gil
A
A
Department of General Surgery, Clinica Universitaria of Navarra, 31008 Navarra, Pamplona, Spain. agilrendo@unav.es
Martínez-Regueira
F
F
Hernández-Lizoain
J L
JL
Pardo
F
F
Olea
J M
JM
Bastarrika
G
G
Cienfuegos
J A
JA
Bilbao
J I
JI
D000008:Abdominal Neoplasms / Q000150:complications / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical; D000075202:Contraindications; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage