Portal Hypertension Surgery — Procedure Guide, Recovery & Risks | MyMedicPlus

Portal hypertension surgery encompasses interventions that reduce elevated portal venous pressure to prevent or treat variceal haemorrhage, ascites, and hepatic encephalopathy in patients with cirrhosis or portal vein thrombosis. Options include TIPS (transjugular intrahepatic portosystemic shunt), surgical portosystemic shunts, and liver transplantation.

Indications include recurrent variceal bleeding uncontrolled by endoscopic band ligation and pharmacotherapy (propranolol plus nitrates), refractory ascites, Budd-Chiari syndrome, hepatic hydrothorax, and as a bridge to liver transplantation. Child-Pugh and MELD scores guide intervention eligibility.

TIPS is performed by interventional radiology via jugular vein access. A covered stent-graft creates a channel between the hepatic and portal veins under fluoroscopic guidance, reducing portal pressure gradient to under 12 mmHg. Surgical shunts (distal splenorenal or mesocaval) reroute portal blood flow to systemic veins under general anaesthesia.

After TIPS, patients are monitored for 48–72 hours for encephalopathy. Regular Doppler ultrasound at 3 and 6 months monitors shunt patency. Dietary sodium restriction and diuretics continue for ascites. Liver transplant recipients require lifelong immunosuppression with tacrolimus-based regimens.

TIPS risks include hepatic encephalopathy (20–30%), shunt dysfunction or occlusion, haemoperitoneum, and acute liver decompensation. Surgical shunts carry higher operative mortality in Child-Pugh C patients. Variceal rebleeding after failed TIPS approaches 10–15% at one year.

TIPS controls acute variceal haemorrhage in 90–95% of cases. One-year shunt patency with covered PTFE stents exceeds 85%. TIPS reduces rebleeding risk by 70% compared to endoscopic therapy alone. Liver transplantation achieves 5-year survival of 70–80% in selected candidates, offering definitive correction of portal hypertension.