Transjugular intrahepatic portasystemic shunt vs surgical shunt in good-risk cirrhotic patients: a case-control comparison

Arch Surg. 2001 Jan;136(1):17-20. doi: 10.1001/archsurg.136.1.17.


Hypothesis: In good-risk patients with variceal bleeding undergoing portal decompression, surgical shunt is more effective, more durable, and less costly than angiographic shunt (transjugular intrahepatic portasystemic shunt [TIPS]).

Design: Retrospective case-control study.

Setting: Academic referral center for liver disease.

Patients: Patients with Child-Pugh class A or B cirrhosis with at least 1 prior episode of bleeding from portal hypertension (gastroesophageal varices, portal hypertensive gastropathy).

Intervention: Portal decompression by angiographic (TIPS) or surgical (portacaval, distal splenorenal) shunt.

Main outcome measures: Thirty-day and long-term mortality, postintervention diagnostic procedures (endoscopic, ultrasonographic, and angiographic studies), hospital readmissions, variceal rebleeding episodes, blood transfusions, shunt revisions, and hospital and professional charges.

Results: Patients with Child-Pugh class A or B cirrhosis undergoing TIPS (n = 20) or surgical shunt (n = 20) were followed up for 385 and 456 patient-months, respectively. Thirty-day mortality was greater following TIPS compared with surgical shunt (20% vs 0%; P =.20); long-term mortality did not differ. Significantly more rebleeding episodes (P<.001); rehospitalizations (P<.05); diagnostic studies of all types (P<.001); shunt revisions (P<.001); and hospital (P<.005), professional (P<.05), and total (P<. 005) charges occurred following TIPS compared with surgical shunt.

Conclusions: Operative portal decompression is more effective, more durable, and less costly than TIPS in Child-Pugh class A and B cirrhotic patients with variceal bleeding. Good-risk patients with portal hypertensive bleeding should be referred for surgical shunt.

MeSH terms

  • Case-Control Studies
  • Costs and Cost Analysis
  • Esophageal and Gastric Varices / etiology*
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / surgery*
  • Humans
  • Hypertension, Portal / complications
  • Hypertension, Portal / etiology
  • Hypertension, Portal / surgery*
  • Liver Cirrhosis / complications*
  • Male
  • Middle Aged
  • Portasystemic Shunt, Surgical* / economics
  • Portasystemic Shunt, Surgical* / mortality
  • Portasystemic Shunt, Transjugular Intrahepatic* / economics
  • Portasystemic Shunt, Transjugular Intrahepatic* / mortality
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome