title: Risk of hernia incarceration following transjugular intrahepatic portosystemic shunt placement.
abstract: OBJECTIVE
  Hernia complications after creation of a transjugular intrahepatic portosystemic shunt (TIPS) have been reported, although the incidence of this complication is unknown. This study was designed to determine the incidence, morbidity, and outcome of hernia complications in patients with preexisting abdominal or inguinal hernias after TIPS creation.
  
  
  METHODS
  The medical records of 244 consecutive patients undergoing TIPS creation between 1999 and 2007 at a single institution were reviewed. The study population was 57 patients (23%) with a preprocedural abdominal or inguinal hernia. The investigated outcome was small bowel obstruction or postprocedural incarceration of a preexisting hernia. Demographic and procedural variables were evaluated for an associated increased risk of hernia complications.
  
  
  RESULTS
  Hernia complications developed in 25% of patients (14 of 57) after TIPS creation at a mean presentation of 62 days (range, 2-588 d). Thirteen complications (93%) required emergent surgery, of which four (29%) required bowel resection for necrosis. There were no resulting deaths. Ninety-eight percent of patients with a hernia complication had the procedure to treat refractory ascites. The indication of refractory ascites was significantly associated with the risk of a hernia complication (P = .002).
  
  
  CONCLUSIONS
  A 25% incidence of hernia complications following TIPS creation in patients being treated for refractory ascites is higher than expected; emergent surgery is required in most cases. Further investigation to formulate a plan for elective management is warranted.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Colorado Denver, 12700 E. 19th Ave, Room P15-1205, Aurora, CO 80045. Electronic address: mitchell.smith@ucdenver.edu.
authors.forename: Mitchell T
authors.initials: MT
authors.lastname: Smith
authors.affiliation: Department of Radiology, University of Colorado School of Medicine, Denver, Colorado.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rase
authors.affiliation: Department of Radiology, David Grant Medical Center, Travis AFB, California.
authors.forename: Alyn
authors.initials: A
authors.lastname: Woods
authors.affiliation: Liver Transplantation Center, Baylor University Medical Center at Dallas, Dallas, Texas.
authors.forename: James
authors.initials: J
authors.lastname: Trotter
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Colorado Denver, 12700 E. 19th Ave, Room P15-1205, Aurora, CO 80045.
authors.forename: Matt
authors.initials: M
authors.lastname: Gipson
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Colorado Denver, 12700 E. 19th Ave, Room P15-1205, Aurora, CO 80045.
authors.forename: Kimi
authors.initials: K
authors.lastname: Kondo
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Colorado Denver, 12700 E. 19th Ave, Room P15-1205, Aurora, CO 80045.
authors.forename: Charles
authors.initials: C
authors.lastname: Ray
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Colorado Denver, 12700 E. 19th Ave, Room P15-1205, Aurora, CO 80045.
authors.forename: Janette
authors.initials: J
authors.lastname: Durham
mesh_terms: D000368:Aged; D001201:Ascites / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D003120:Colorado / Q000453:epidemiology; D005260:Female; D046449:Hernia, Abdominal / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: TIPS; transjugular intrahepatic portosystemic shunt