Surgical Shunting Versus Trans-Jugular Intrahepatic Portosystemic Shunt for Recurrent Variceal Bleeding in Portal Hypertension Due to Liver Cirrhosis: An Evidence-Based Case Report

Nadya Magfira(1), Arie Rozzaqi Nurrafiani(2), Chyntia Olivia Maurine Jasirwan(3), Raden Suhartono(4),

(1) Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General National Hospital, Jakarta
(2) Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General National Hospital, Jakarta
(3) Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General National Hospital, Jakarta
(4) Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General National Hospital, Jakarta
Corresponding Author


Aim: This evidence-based case report aims to determine whether the surgical shunt is better than the trans-jugular intrahepatic portosystemic shunt (TIPS) to prevent re-bleeding in patients with portal hypertension due to liver cirrhosis.  

Method: Literature searching was performed in 4 online databases, Cochrane, PubMed, Embase, and SCOPUS. Three meta-analyses were appraised critically.

Results: Of all meta-analyses included, the internal validities were poor and only included a small number of trials. However, the results show that surgical shunt is better for preventing variceal re-bleeding with varied heterogeneities.

Conclusion: Surgical shunts may have benefits over TIPS in preventing variceal re-bleeding.



portal hypertension; secondary prevention; surgical portosystemic shunt; trans-jugular intrahepatic portosystemic shunt (TIPS); variceal re-bleeding


Mallet M, Rudler M, Thabut D. Variceal bleeding in cirrhotic

patients. Gastroenterol Rep (Oxf). 2017;5(3):185-92.

Brand M, Prodehl L, Ede CJ. Surgical portosystemic shunts

versus transjugular intrahepatic portosystemic shunt for

variceal haemorrhage in people with cirrhosis. Cochrane

Database Syst Rev. 2018;10(10):CD001023.

Alqahtani SA, Jang S. Pathophysiology and Management of

Variceal Bleeding. Drugs. 2021;81(6):647-67.

Tzimas D, Bucobo JC, Telem D. Management of Esophageal

Variceal Bleeding. Gastrointestinal Bleeding: Springer

International Publishing; 2016. p. 27-39.

Oxford CfE-BMUo. Systematic Reviews Critical Appraisal

Sheet2022 September 14 2022. Available from: https://www.

Huang L, Yu QS, Zhang Q, Liu JD, Wang Z. Transjugular

intrahepatic portosystemic shunt versus surgical shunting in

the management of portal hypertension. Chin Med J (Engl).


Zhou GP, Sun LY, Wei L, Qu W, Zeng ZG, Liu Y, et

al. Comparision between portosystemic shunts and

endoscopic therapy for prevention of variceal re-bleeding:

a systematic review and meta-analysis. Chin Med J (Engl).


Gur I, Diggs BS, Orloff SL. Surgical portosystemic shunts

in the era of TIPS and liver transplantation are still relevant.

HPB (Oxford). 2014;16(5):481-93.

Orloff MJ, Hye RJ, Wheeler HO, Isenberg JI, Haynes KS,

Vaida F, et al. Randomized trials of endoscopic therapy and

transjugular intrahepatic portosystemic shunt versus portacaval

shunt for emergency and elective treatment of bleeding gastric

varices in cirrhosis. Surgery. 2015;157(6):1028-45.

Orloff MJ, Vaida F, Haynes KS, Hye RJ, Isenberg JI,

Jinich-Brook H. Randomized controlled trial of emergency

transjugular intrahepatic portosystemic shunt versus

emergency portacaval shunt treatment of acute bleeding

esophageal varices in cirrhosis. J Gastrointest Surg.


Rosemurgy AS, Frohman HA, Teta AF, Luberice K, Ross

SB. Prosthetic H-graft portacaval shunts vs transjugular

intrahepatic portasystemic stent shunts: 18-year follow-up

of a randomized trial. J Am Coll Surg. 2012;214(4):445-53;

discussion 53-5.

Henderson JM, Boyer TD, Kutner MH, Galloway JR,

Rikkers LF, Jeffers LJ, et al. Distal splenorenal shunt

versus transjugular intrahepatic portal systematic shunt for

variceal bleeding: a randomized trial. Gastroenterology.


Garcia-Pagán JC, Eu JCP. Noncirrhotic portal hypertension:

UpTodate; 2021 [updated Aug 12, 2021. Available from:

Bochnakova T. Hepatic Venous Pressure Gradient. Clin Liver

Dis (Hoboken). 2021;17(3):144-8.

Boregowda U, Umapathy C, Halim N, Desai M, Nanjappa

A, Arekapudi S, et al. Update on the management of

gastrointestinal varices. World J Gastrointest Pharmacol Ther.


D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and

prognostic indicators of survival in cirrhosis: a systematic

review of 118 studies. J Hepatol. 2006;44(1):217-31.

Horhat A, Bureau C, Thabut D, Rudler M. Transjugular

intrahepatic portosystemic shunt in patients with cirrhosis:

Indications and posttransjugular intrahepatic portosystemic

shunt complications in 2020. United European Gastroenterol

J. 2021;9(2):203-8.

Suhocki PV, Lungren MP, Kapoor B, Kim CY. Transjugular

intrahepatic portosystemic shunt complications: prevention

and management. Semin Intervent Radiol. 2015;32(2):123-32.

Full Text: PDF PDF

Article Metrics

Abstract View : 201 times
PDF Download : 112 times PDF Download : 38 times

DOI: 10.24871/2432023264


  • There are currently no refbacks.