| Title: |
Transjugular Intrahepatic Portosystemic Shunt (TIPS): A Bridge to Bariatric Surgery in Morbidly Obese Patients with Cirrhosis and Clinically Significant Portal Hypertension. |
| Authors: |
Pais, Raluca, Chouik, Yasmina, Moga, Lucile, Lebedel, Louise, Silvain, Christine, Genser, Laurent, Weill, Delphine, Larrue, Hélène, Malézieux, Emilie, Jezéquel, Caroline, Robert, Maud, Regnault, Hélène, Dumortier, Jérôme, Ratziu, Vlad, Thabut, Dominique, Rudler, Marika |
| Source: |
Obesity Surgery; Feb2025, Vol. 35 Issue 2, p395-405, 11p |
| Subject Terms: |
ESOPHAGEAL varices, PORTAL hypertension, VENOUS pressure, BARIATRIC surgery, LIVER failure |
| Abstract: |
Background: In cirrhotic patients, portal hypertension increases mortality after surgery. We evaluated the impact of pre-operative transjugular intrahepatic portosystemic shunt (TIPS) on the outcomes of bariatric surgery in cirrhosis. Methods: Multicentric retrospective cohort. The decision for TIPS placement has been made according to hepatic venous pressure gradient (HVPG) values and centers' policy. The primary outcome: 1-year decompensation-free survival; secondary outcomes: 1-year acute-on-chronic liver failure (ACLF) and survival. Results: Fifty-three patients were included (2010–2022): 92% Child–Pugh A, MELD score 8, age 55 years, BMI 38.3 ± 13 kg/m2, 9 (18%) had TIPS. At baseline, patients with TIPS had more esophageal varices (89% vs 10%, p < 0.001), more previous decompensations (22% vs 0%, p = 0.002), and a higher HVPG (14 vs 7 mmHg, p < 0.001). All patients in the TIPS group had clinically significant portal hypertension vs 11% of patients without TIPS, p < 0.001. One-year decompensation-free survival was 77.8% and 93.2% in patients with and without TIPS, p = 0.064. ALCF occurred in 3 patients (6.8%) without TIPS and none with TIPS. All patients were alive 1 year after surgery. Conclusions: In patients with cirrhosis and clinically significant portal hypertension (CSPH) undergoing bariatric surgery, TIPS placement was safe and had similar outcomes after surgery as patients without TIPS. [ABSTRACT FROM AUTHOR] |
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| Database: |
Complementary Index |
