Surgery versus transjugular intrahepatic portal systemic shunt in the treatment of severe variceal bleeding.
The management of patients who have portal hypertension has changed dramatically over the last 2 decades. Pharmacologic therapy benefits the patient by reducing the risk for an initial bleed, improving the management of an acute bleed, and in reducing the risk for a rebleed. Endoscopic management has improved progressively along with endoscopic technology. For those 20% of patients that continues to have persistent high-risks varices or rebleed through first-line therapy, decompression does remain an option. The three options to decompression are liver transplant, a surgical shunt, or a transjugular intrahepatic portal systemic shunt (TIPS). This article focuses on the relative roles of these options with a particular emphasis on the current available data comparing surgical shunt with TIPS.
Henderson
J Michael
JM
Division of Surgery, E32, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. henderm@ccf.org
D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D016031:Liver Transplantation; D008297:Male; D011170:Portasystemic Shunt, Surgical / Q000379:methods*