Transjugular intrahepatic portosystemic shunt does not improve colectomy outcomes

Last Updated: 2015-01-09

By Reuters Staff

NEW YORK (Reuters Health) - Transjugular intrahepatic portosystemic shunt (TIPS) does not improve colectomy outcomes in patients with concomitant primary sclerosing cholangitis (PSC) and ulcerative colitis, according to results from a retrospective study.

Patients with PSC and ulcerative colitis face a high risk of colon cancer, but colectomy in these patients may be associated with major complication rates as high as 27%.

Some have suggested that TIPS prior to abdominal surgery in PSC patients with cirrhosis can improve surgical outcomes, but studies have yielded conflicting results.

Dr. Bo Shen from The Cleveland Clinic in Ohio and colleagues investigated whether TIPS prior to colectomy in patients who have both PSC and ulcerative colitis alters the rates of postoperative complications in a retrospective case-control study of 50 patients, 9 of whom received TIPS before their colectomy.

Patients who had TIPS before surgery experienced several complications with greater frequency, compared with the 37 patients who did not have TIPS before colectomy, according to the article published online December 16 in Gastroenterology Report.

The TIPS group had significantly more intraoperative bleeding that required blood transfusions, more wound infections, a higher risk of wound dehiscence, and a higher chance of readmission within 30 days than did the non-TIPS group.

Postoperative mortality, however, did not differ between the groups.

There were several significant differences between the groups that could have contributed to the worse outcomes. The TIPS group had higher median Mayo Risk Scores, lower mean albumin levels, higher total bilirubin levels, lower hemoglobin and platelet levels, higher international normal ratio values, and longer activated partial thromboplastin time.

"Our findings suggest that the cause was not the presence of TIPS, but rather that patients in the Study group had more severe cirrhosis, which made both TIPS placement and post-colectomy complications more likely," the researchers say.

It remains to be seen, then, whether TIPS placement itself exacerbates or diminishes surgical complications.

"Based on our initial findings," the authors conclude, "prospective tracking of patients with PSC and ulcerative colitis undergoing colectomy following TIPS may be warranted."

Dr. Shen did not respond to a request for comments.

SOURCE: http://bit.ly/1Kt6sXF

Gastroenterol Rep 2014