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Role of TIPS and Surgery in Prevention of Rebleeding

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Variceal Hemorrhage

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Abstract

Porto-caval shunting has consistently been found to be the most effective treatment to prevent variceal bleeding. Shunting has over other treatments the advantage of normalizing portal pressure, which relieves and/or prevents not only rebleeding but also the other complications of portal hypertension. Surgical techniques can be classified into three main categories: shunting techniques either total or selective, selective variceal decompression, and devascularization procedures. As a whole, shunting was more effective than alternative treatments in preventing rebleeding, though survival was not improved and the incidence of HE was increased.

Surgical shunting has been virtually abandoned because of the development of interventional radiology techniques, mainly trans-jugular intrahepatic porto-systemic shunt (TIPS).

Whenever possible, liver transplantation should be considered in these patients whose liver function is usually poor. When it is contraindicated as well as in patients on the waiting list, or the few whose liver function is fairly preserved, a shunting procedure should be considered.

Nowadays, whenever a shunting procedure is considered needed, TIPS with PTFE-covered stents should be preferred to surgery because it avoids the complications of laparotomy, it does not hamper the chance for transplantation, and it can be reduced in diameter or occluded if needed because of the occurrence of refractory hepatic encephalopathy. Only in the few situations where TIPS cannot be performed, e.g., complete portal vein obstruction or cavernoma, devascularization techniques can be attempted.

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  1. Service d’Hepato-Gastro-Enterologie, Hopital Purpan CHU Toulouse et Universite Paul Sabatier, Place du Dr. Baylac, Toulouse, 31059, France

    Christophe Bureau & Jean-Pierre Vinel

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  1. Luigi Sacco University Hospital, University of Milan, Milan, Italy

    Roberto de Franchis

  2. Ospedale Universitario Luigi Sacco, Universitá degli Studi di Milano, UOC Gastroenterologia, Milano, Italy

    Alessandra Dell’Era

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Bureau, C., Vinel, JP. (2014). Role of TIPS and Surgery in Prevention of Rebleeding. In: de Franchis, R., Dell’Era, A. (eds) Variceal Hemorrhage. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0002-2_17

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