Transjugular Intrahepatic Portosystemic Shunt Versus Surgical Shunting in the Management of Portal Hypertension

Background： The purpose of this article was to clarify the optimal management concerning transjugular intrahepatic portosystemic shunts （TIPSs） and surgical shunting in treating portal hypertension. Methods： All databases, including CBM, CNKI, WFPD, Medline, EMBASE, PubMed and Cochrane up to February 2014, were searched for randomized controlled trials （RCTs） comparing TIPS with surgical shunting. Four RCTs, which were extracted by two independent investigators and were evaluated in postoperative complications, mortality, 2- and 5-year survival, hospital stay, operating time and hospitalization charges. Results： The morbidity in variceal rehemorrhage was significantly higher in TIPS than in surgical shunts （odds ratio [OR] = 7.45, 95% confidence interval[C/]： （3.93-14.15）, P 〈 0.00001）, the same outcomes were seen in shunt stenosis （OR = 20.01,95% CI： （6.67-59.99）, P 〈 0.000001 ） and in hepatic encephalopathy （OR = 2.50, 95% CI： （1.63-3.84）, P 〈 0.0001 ）. Significantly better 2-year survival （OR = 0.66; 95% CI： （0.44-0.98）, P ~ 0.04） and 5-year survival （OR = 0.44; 95% CI： （0.30-0.66）, P 〈 0.00001） were seen in patients undergoing surgical shunting compared with TIPS. Conclusions： Compared with TIPS, postoperative complications and survival after surgical shunting were superior for patients with portal hypertension. Application of surgical shunting was recommended for patients rather than TIPS.