Don’t Shun the Shunt: Surgical Portosystemic Shunts in the Era of TIPS and Liver Transplantation

Abstract

Port-systemic shunt surgery has been on the retreat in the past 
20-years with the advent of minimally invasive techniques like 
transjugular intrahepatic portosystemic shunts (TIPS) and wider 
use of liver transplantation as the definitive treatment of end-stage 
liver disease. There is also increasing awareness of the limitations 
of surgical portal decompression. In the clinical context of poor 
hepatic function, such as in Child’s B and C patients, decompression often precipitates incapacitating hepatic encephalopathy and 
may actually increase mortality.