In this systematic review and meta-analysis, we examined the evidence on transjugular intrahepatic portosystemic shunt (TIPS) as a bridge to elective and emergency surgery in cirrhotic patients. We aimed to assess the perioperative characteristics, management approaches, and outcomes of this intervention, which is used to achieve portal decompression and enable the safe performance of elective and emergent surgery. MEDLINE and Scopus were searched for studies reporting the outcomes of cirrhotic patients undergoing elective and emergency surgery with preoperative TIPS. The risk of bias was evaluated using the methodological index for non-randomized studies of interventions, and the JBI critical appraisal tool for case reports. The outcomes of interest were: 1. Surgery after TIPS; 2. Mortality; 3. Perioperative transfusions; and 4. Postoperative liver-related events. A DerSimonian and Laird (random-effects) model was used to perform the meta-analyses in which the overall (combined) effect estimate was presented in the form of an odds ratio (summary statistic). Of 426 patients (from 27 articles), 256 (60.1%) underwent preoperative TIPS. Random effects MA showed significantly lower odds of postoperative ascites with preoperative TIPS (OR = 0.40, 95% CI 0.22–0.72; I2 = 0%). There were no significant differences in 90-day mortality (3 studies: OR = 0.76, 95% CI 0.33–1.77; I2 = 18.2%), perioperative transfusion requirement (3 studies: OR = 0.89, 95% CI 0.28–2,84; I2 = 70.1%), postoperative hepatic encephalopathy (2 studies: OR = 0.97, 95% CI 0.35–2.69; I2 = 0%), and postoperative ACLF (3 studies: OR = 1.02, 95% CI 0.15–6.8, I2 = 78.9%). Preoperative TIPS appears safe in cirrhotic patients who undergo elective and emergency surgery and may have a potential role in postoperative ascites control. Future randomized clinical trials should test these preliminary results.

中文翻译：

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释放 TIPS 放置作为肝硬化患者择期手术和急诊手术桥梁的潜力：急性护理手术中血管内复苏的荟萃分析和未来方向

在这项系统评价和荟萃分析中，我们检查了经颈静脉肝内门体分流术 (TIPS) 作为肝硬化患者择期和急诊手术的桥梁的证据。我们的目的是评估这种干预的围手术期特征、管理方法和结果，该干预用于实现门静脉减压并确保择期和急诊手术的安全进行。在 MEDLINE 和 Scopus 中搜索报告肝硬化患者接受择期和急诊手术并采用术前 TIPS 的结果的研究。使用非随机干预研究的方法学指标和病例报告的 JBI 关键评估工具评估偏倚风险。感兴趣的结果是： 1. TIPS 后手术；2.死亡率；3. 围手术期输血；和 4。术后肝脏相关事件。DerSimonian 和 Laird（随机效应）模型用于执行荟萃分析，其中总体（组合）效应估计以比值比（汇总统计）的形式呈现。在 426 名患者（来自 27 篇文章）中，256 名 (60.1%) 接受了术前 TIPS。随机效应 MA 显示术前 TIPS 术后腹水的几率显着降低（OR = 0.40，95% CI 0.22–0.72；I2 = 0%）。90 天死亡率（3 项研究：OR = 0.76，95% CI 0.33–1.77；I2 = 18.2%）、围手术期输血需求（3 项研究：OR = 0.89，95% CI 0.28–2,84）无显着差异；I2 = 70.1%）、术后肝性脑病（2 项研究：OR = 0.97，95% CI 0.35–2.69；I2 = 0%）和术后 ACLF（3 项研究：OR = 1.02，95% CI 0.15–6.8，I2 = 78.9%)。对于接受择期和急诊手术的肝硬化患者，术前 TIPS 似乎是安全的，并且可能在控制术后腹水方面发挥潜在作用。未来的随机临床试验应测试这些初步结果。