Cargando…

Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center

OBJECTIVE: Transjugular intrahepatic portosystemic shunt (TIPS) placement is used to treat the sequelae of portal hypertension, including refractory variceal bleeding, ascites and hepatic hydrothorax. However, hernia-related complications such as incarceration and small bowel obstruction can occur a...

Descripción completa

Detalles Bibliográficos
Autores principales: McDaniel, Charles, Bell, Ruth, Farha, Natalie, Vozzo, Catherine, Bullen, Jennifer, Rosen, Michael, Romero-Marrero, Carlos, Partovi, Sasan, Kapoor, Baljendra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943763/
https://www.ncbi.nlm.nih.gov/pubmed/35318192
http://dx.doi.org/10.1136/bmjgast-2022-000876
_version_ 1784673584848830464
author McDaniel, Charles
Bell, Ruth
Farha, Natalie
Vozzo, Catherine
Bullen, Jennifer
Rosen, Michael
Romero-Marrero, Carlos
Partovi, Sasan
Kapoor, Baljendra
author_facet McDaniel, Charles
Bell, Ruth
Farha, Natalie
Vozzo, Catherine
Bullen, Jennifer
Rosen, Michael
Romero-Marrero, Carlos
Partovi, Sasan
Kapoor, Baljendra
author_sort McDaniel, Charles
collection PubMed
description OBJECTIVE: Transjugular intrahepatic portosystemic shunt (TIPS) placement is used to treat the sequelae of portal hypertension, including refractory variceal bleeding, ascites and hepatic hydrothorax. However, hernia-related complications such as incarceration and small bowel obstruction can occur after TIPS placement in patients with pre-existing hernias. The aim of this study was to determine the incidence of hernia complications in the first year after TIPS placement and to identify patient characteristics leading to an increased risk of these complications. DESIGN: This retrospective analysis included patients with pre-existing abdominal hernias who underwent primary TIPS placement with covered stents at our institution between 2004 and 2018. The 1-year hernia complication rate and the average time to complications were documented. Using a Wilcoxon rank-sum test, the characteristics of patients who developed hernia-related complications versus the characteristics of those without complications were compared. RESULTS: A total of 167 patients with pre-existing asymptomatic abdominal hernias were included in the analysis. The most common reason for TIPS placement was refractory ascites (80.6%). A total of 36 patients (21.6%) developed hernia-related complications after TIPS placement, including 20 patients with acute complications and 16 with non-acute complications. The mean time to presentation of hernia-related complications was 66 days. Patients who developed hernia-related complications were more likely than those without complications to have liver cirrhosis secondary to alcohol consumption (p=0.049), although this association was no longer significant after multivariate analysis. CONCLUSION: Within 1 year after TIPS placement, approximately 20% of patients with pre-existing hernias develop hernia-related complications, typically within the first 2 months after the procedure. Patients with pre-existing hernia undergoing TIPS placement should be educated regarding the signs and symptoms of hernia-related complications, including incarceration and small bowel obstruction.
format Online
Article
Text
id pubmed-8943763
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-89437632022-04-08 Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center McDaniel, Charles Bell, Ruth Farha, Natalie Vozzo, Catherine Bullen, Jennifer Rosen, Michael Romero-Marrero, Carlos Partovi, Sasan Kapoor, Baljendra BMJ Open Gastroenterol Hepatology OBJECTIVE: Transjugular intrahepatic portosystemic shunt (TIPS) placement is used to treat the sequelae of portal hypertension, including refractory variceal bleeding, ascites and hepatic hydrothorax. However, hernia-related complications such as incarceration and small bowel obstruction can occur after TIPS placement in patients with pre-existing hernias. The aim of this study was to determine the incidence of hernia complications in the first year after TIPS placement and to identify patient characteristics leading to an increased risk of these complications. DESIGN: This retrospective analysis included patients with pre-existing abdominal hernias who underwent primary TIPS placement with covered stents at our institution between 2004 and 2018. The 1-year hernia complication rate and the average time to complications were documented. Using a Wilcoxon rank-sum test, the characteristics of patients who developed hernia-related complications versus the characteristics of those without complications were compared. RESULTS: A total of 167 patients with pre-existing asymptomatic abdominal hernias were included in the analysis. The most common reason for TIPS placement was refractory ascites (80.6%). A total of 36 patients (21.6%) developed hernia-related complications after TIPS placement, including 20 patients with acute complications and 16 with non-acute complications. The mean time to presentation of hernia-related complications was 66 days. Patients who developed hernia-related complications were more likely than those without complications to have liver cirrhosis secondary to alcohol consumption (p=0.049), although this association was no longer significant after multivariate analysis. CONCLUSION: Within 1 year after TIPS placement, approximately 20% of patients with pre-existing hernias develop hernia-related complications, typically within the first 2 months after the procedure. Patients with pre-existing hernia undergoing TIPS placement should be educated regarding the signs and symptoms of hernia-related complications, including incarceration and small bowel obstruction. BMJ Publishing Group 2022-03-22 /pmc/articles/PMC8943763/ /pubmed/35318192 http://dx.doi.org/10.1136/bmjgast-2022-000876 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Hepatology
McDaniel, Charles
Bell, Ruth
Farha, Natalie
Vozzo, Catherine
Bullen, Jennifer
Rosen, Michael
Romero-Marrero, Carlos
Partovi, Sasan
Kapoor, Baljendra
Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center
title Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center
title_full Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center
title_fullStr Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center
title_full_unstemmed Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center
title_short Risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center
title_sort risk of hernia-related complications after transjugular intrahepatic portosystemic shunt creation in patients with pre-existing ventral abdominal hernias: 15-year experience at a quaternary medical center
topic Hepatology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943763/
https://www.ncbi.nlm.nih.gov/pubmed/35318192
http://dx.doi.org/10.1136/bmjgast-2022-000876
work_keys_str_mv AT mcdanielcharles riskofherniarelatedcomplicationsaftertransjugularintrahepaticportosystemicshuntcreationinpatientswithpreexistingventralabdominalhernias15yearexperienceataquaternarymedicalcenter
AT bellruth riskofherniarelatedcomplicationsaftertransjugularintrahepaticportosystemicshuntcreationinpatientswithpreexistingventralabdominalhernias15yearexperienceataquaternarymedicalcenter
AT farhanatalie riskofherniarelatedcomplicationsaftertransjugularintrahepaticportosystemicshuntcreationinpatientswithpreexistingventralabdominalhernias15yearexperienceataquaternarymedicalcenter
AT vozzocatherine riskofherniarelatedcomplicationsaftertransjugularintrahepaticportosystemicshuntcreationinpatientswithpreexistingventralabdominalhernias15yearexperienceataquaternarymedicalcenter
AT bullenjennifer riskofherniarelatedcomplicationsaftertransjugularintrahepaticportosystemicshuntcreationinpatientswithpreexistingventralabdominalhernias15yearexperienceataquaternarymedicalcenter
AT rosenmichael riskofherniarelatedcomplicationsaftertransjugularintrahepaticportosystemicshuntcreationinpatientswithpreexistingventralabdominalhernias15yearexperienceataquaternarymedicalcenter
AT romeromarrerocarlos riskofherniarelatedcomplicationsaftertransjugularintrahepaticportosystemicshuntcreationinpatientswithpreexistingventralabdominalhernias15yearexperienceataquaternarymedicalcenter
AT partovisasan riskofherniarelatedcomplicationsaftertransjugularintrahepaticportosystemicshuntcreationinpatientswithpreexistingventralabdominalhernias15yearexperienceataquaternarymedicalcenter
AT kapoorbaljendra riskofherniarelatedcomplicationsaftertransjugularintrahepaticportosystemicshuntcreationinpatientswithpreexistingventralabdominalhernias15yearexperienceataquaternarymedicalcenter