Minilaparotomy-Assisted Transmesenteric-Transjugular Intrahepatic Portosystemic Shunt: Comparison with Conventional Transjugular Approach.
OBJECTIVE
This study was performed to compare the intrahepatic shunt function outcome and procedural complications of minilaparotomy-assisted transmesenteric (MAT)-transjugular intrahepatic portosystemic shunt (TIPS) placement with the conventional transjugular method.


METHODS
This is a retrospective review of all patients who had a MAT or conventional TIPS procedure over a 6-year period at our institute. The primary patency rate, fluoroscopy time, technical success, major procedure-related complications, and mortality data were compared between two treatment groups.


RESULTS
We included 49 patients with MAT-TIPS, and 63 with conventional TIPS, with an average follow-up of 21.43 months. The primary patency rates at 6 and 12 months were 82.9 and 66.7 % in the conventional TIPS group, and 81.0 and 76.5 % in the MAT-TIPS group (p = 1.000, and 0.529), respectively. There was no significant difference in technical success rate, post-procedure portosystemic pressure gradient, fluoroscopy time, and peri-procedural mortality rate between treatment groups. Major procedural-related complications were seen more frequently among MAT-TIPS patients (p = 0.012). In the MAT-TIPS group, 5 (10.2 %) patients developed post-procedure minilaparotomy, wound-related complications, and 5 (10.2 %) developed bacterial peritonitis; whereas, none of patients with conventional TIPS had either of these complications (p = 0.014).


CONCLUSIONS
While both MAT-TIPS and conventional TIPS had similar shunt primary patency rate and technical success rate, the MAT approach was associated with a significantly higher rate of minilaparotomy-related wound complications or infectious complications. These complications maybe prevented by a change in post-procedure monitoring and therapy.
Division of Interventional Radiology, Department of Radiology, University of Minnesota, Mayo B228, 420 Delaware Street SE, Minneapolis, MN, 55455, USA. hjalaeia@umn.edu.
Hamed
H
Jalaeian
Division of Interventional Radiology, Department of Radiology, University of Minnesota, Mayo B228, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
Reza
R
Talaie
Division of Interventional Radiology, Department of Radiology, University of Minnesota, Mayo B228, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
Donna
D
D'Souza
Division of Interventional Radiology, Department of Radiology, University of Minnesota, Mayo B228, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
Shayandokht
S
Taleb
School of Medicine, University of Minnesota, Minneapolis, MN, USA.
Siamak
S
Noorbaloochi
Division of Interventional Radiology, Department of Radiology, University of Minnesota, Mayo B228, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
Siobhan
S
Flanagan
Division of Interventional Radiology, Department of Radiology, University of Minnesota, Mayo B228, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
David
D
Hunter
Division of Interventional Radiology, Department of Radiology, University of Minnesota, Mayo B228, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
Jafar
J
Golzarian
D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
MAT-TIPS; Minilaparotomy; Transjugular intrahepatic portosystemic shunt