Outcomes of surgical shunts and transjugular intrahepatic portasystemic stent shunts for complicated portal hypertension. BJS 2017; 104: 443-451.

Results

A total of 471 patients received either a surgical shunt or TIPSS. Of these, 334 consecutive patients with cirrhosis who underwent elective surgical shunting (34) or TIPSS (300) for repeated variceal bleeding or refractory ascites were evaluated. Propensity score matching yielded 31 pairs of patients. There were no between‐group differences in morbidity and 30‐day mortality rates. However, shunt failure was less frequent after surgical shunting than TIPSS (6 of 31 versus 16 of 31; P = 0·016). The 5‐year shunt failure‐free survival (77 versus 15 per cent; P = 0·008) and overall survival (93 versus 42 per cent; P = 0·037) rates were higher for patients with surgical shunts. Multivariable analysis revealed that a Model for End‐Stage Liver Disease (MELD) score exceeding14 and TIPSS were independently associated with shunt failure. In patients with MELD scores of 14 or less, the 5‐year overall survival rate remained higher after surgical shunting than TIPSS (100 versus 40 per cent; P < 0·001).