Which patients with cirrhosis and portal hypertension are ideal candidates to undergo TIPS to reduce perioperative risk in anticipation of an elective surgery?

A pre-operatively placed TIPS may have a role in preventing hepatic decompensation and post-surgical complications in carefully selected patients undergoing elective abdominal surgery.

The data to support TIPS pre-operatively is limited, given the varying surgical contexts and the generally poor prognosis of decompensated cirrhosis. Thus, pre-operative TIPS should be considered on a case-by-case basis, and there does not appear to be a role for pre-op TIPS in non-abdominal/pelvic surgery.

Benefits:

A TIPS may resolve ascites so that patients with recurrent ascites can safely undergo abdominal wall surgeries (eg hernia repair) and are less likely to have a poorly healing surgical site complicated by the leakage of large ascites, wound infect...