What is Transjugular Intrahepatic Portosystemic Shunt (TIPS)?
Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure designed to create a pathway (shunt) between the portal vein and hepatic vein inside the liver. This helps reduce high blood pressure in the portal vein (portal hypertension) that can occur due to liver diseases such as cirrhosis.
During TIPS, a catheter is inserted through the jugular vein in the neck and guided into the liver under imaging guidance. A stent is placed to connect the portal and hepatic veins, allowing blood to bypass damaged areas of the liver and reduce pressure in the portal system.
TIPS is commonly recommended for patients with complications like variceal bleeding, refractory ascites, or hepatic hydrothorax. Compared to traditional surgery, TIPS is minimally invasive, generally safer, and allows for faster recovery.
Types of Transjugular Intrahepatic Portosystemic Shunt (TIPS) Surgery
TIPS procedures can be categorised based on stent type and clinical purpose:
- Bare Metal Stent TIPS: Uses a traditional metal stent to create a direct pathway between the portal vein and hepatic vein. Often chosen in emergency situations to quickly control variceal bleeding, but may have a higher chance of narrowing over time compared to covered stents.
- Covered Stent TIPS: Features a stent covered with a special material that reduces the risk of blockage and improves long-term patency. It is preferred for patients requiring durable symptom relief and better long-term outcomes.
- Emergency TIPS: Performed urgently in cases of uncontrolled variceal bleeding when medications or endoscopic therapy fail. This type of TIPS can be lifesaving by rapidly reducing portal pressure.
- Elective/Planned TIPS: Scheduled procedure for managing refractory ascites or hepatic hydrothorax. Helps improve quality of life, reduce hospitalisations, and control fluid buildup in a controlled manner.
- Balloon-Expandable TIPS: Uses a balloon to precisely expand the stent for optimal blood flow. This type allows for fine adjustments in shunt size, improving pressure regulation and reducing complications.
1-2 Hours
Surgery Duration
Local Anesthesia
Anesthesia Used
When is TIPS Surgery Recommended?
TIPS is recommended for patients with complications of portal hypertension that cannot be controlled with medications or other non-surgical treatments. Some of the main reasons include:
- Variceal Bleeding: Recurrent or severe bleeding from oesophagal or gastric varices that cannot be managed with endoscopic therapy or medication. TIPS helps reduce pressure in the portal vein to prevent further bleeding.
- Refractory Ascites: Persistent fluid buildup in the abdomen that does not respond to diuretics or dietary measures. TIPS allows the fluid to drain more effectively and reduces abdominal pressure.
- Hepatic Hydrothorax: Fluid accumulation in the chest cavity caused by liver disease that is not responsive to conventional therapy. TIPS helps redirect blood flow and relieve pressure.
- Portal Hypertension: In cases of high portal vein pressure causing splenomegaly, pain, or other organ strain, TIPS may be used to improve overall circulation.
- Bridge to Liver Transplant: TIPS can stabilise patients with severe liver disease while they await liver transplantation, managing complications and improving overall condition before surgery.
Preparing for the Tips Surgery Procedure
Proper preparation ensures a safe TIPS procedure and smooth recovery. Here's what patients can expect:
Medical Evaluation & Pre-Op Tests
- Complete review of your medical history, liver function, medications, and overall health.
- Routine blood tests, liver function tests, imaging (ultrasound, CT, or MRI), and an ECG to assess readiness for the procedure.
- Results are reviewed in advance to plan the procedure and minimize risks.
Health Habits & Lifestyle Adjustments
- Stop smoking at least 4-6 weeks before surgery to improve circulation and healing.
- Avoid alcohol entirely, as it can worsen liver function and affect recovery.
- Certain medications, especially blood thinners, may need to be paused under doctor supervision.
Preparing Your Home & Support System
- Arrange for someone to drive you to and from the hospital.
- Have a comfortable recovery area ready with easy access to water, medications, and essentials.
- Plan light meals in advance, as diet may need adjustment immediately after TIPS.
The Day Before & Day of Surgery
- Follow fasting instructions, typically no food or drink after midnight.
- Shower using any antiseptic soap as directed, and remove jewelry or makeup.
- Wear comfortable, loose clothing that is easy to remove and allows access for monitoring.
What Happens During Tips Surgery?
During TIPS, a stent is inserted through a vein in the neck (jugular vein) to connect the portal and hepatic veins, reducing pressure in the portal system.
- Preparation & Anesthesia: On the day of surgery, your medical team reviews the plan one more time. TIPS is performed under local anesthesia with sedation, keeping you comfortable while remaining conscious or lightly asleep.
- Accessing the Jugular Vein: The surgeon inserts a catheter into the jugular vein in the neck. Using imaging guidance, the catheter is carefully threaded through the veins into the liver.
- Creating the Shunt: A small channel is made between the portal vein and hepatic vein inside the liver. A stent is placed within this channel to keep it open, allowing blood to bypass damaged areas and reduce high portal vein pressure.
- Monitoring & Imaging: Throughout the procedure, advanced imaging techniques are used to guide placement precisely and ensure optimal blood flow. Pressure measurements are taken to confirm the shunt is functioning correctly.
- Finishing the Procedure: Once the stent is securely in place, the catheter is removed, and the entry site in the neck is closed with a small bandage or stitch. Patients are then monitored in a recovery area to ensure stable vitals and proper liver function.
- Post-Surgery Care: Most patients remain under observation for a day or two. Imaging tests may be repeated to check shunt function, and medications are adjusted to prevent blood clots or other complications.
Who Will Perform the TIPS Procedure?
The TIPS procedure is performed by a team of specialists skilled in liver care and minimally invasive techniques.
Recovery After TIPS Surgery Procedure
Recovering from TIPS is usually quicker compared to open surgeries, but careful monitoring is essential for best results.
First Few Days After Surgery
During the 1-3 days, the patients remain in the hospital under observation. A certain amount of neck aches or slight stomachache is normal. Doctors pay much attention to the work of the liver, to the performance of the shunt, and the manifestations of complications. Light walking in the aftermath of the operation facilitates blood flow and mitigates the chances of blood clotting among other risks.
Doctor Tip: "Any confusion, swelling or atypical bleeding needs to be reported immediately as these might be indicative of complications.
Weeks 1 to 4
Majority of patients start feeling better and are able to take light activities. The ascites or swelling usually become significantly better in this time. Frequent follow-up visits and imaging examinations should be done to monitor the shunt is functioning well.
Doctor hint: "Always take your medicine schedule particularly those medicines that prevent clotting, or encephalopathy.
Weeks 5 to 6
By this time, energy levels improve, and patients can return to most normal daily activities. Some dietary adjustments, such as reduced salt intake, may still be recommended to support liver health. Heavy lifting and strenuous exercise should still be avoided unless cleared by your doctor.
Doctor's Tip: "Even if you feel back to normal, avoid overexertion, your liver still needs time to adapt to the new circulation."
3 to 6 Months Post-Surgery
Symptoms like ascites and variceal bleeding are usually well controlled in most of the patients. The aspect of long-term recovery is to take care of the liver disease and also to keep the stent in check so that it does not become obstructed. The end result benefits, such as a better quality of life can be best observed at this point.
Doctor Tip: "Follow-up imaging and liver checks are important in ensuring that your TIPS is working effectively.
Lifestyle Changes After TIPS
- Limit alcohol intake and follow a liver-friendly diet.
- Take prescribed medications to prevent hepatic encephalopathy and monitor liver health.
- Maintain a healthy weight and stay physically active as tolerated.
- Monitor for new symptoms like confusion, abdominal swelling, or bleeding.
Benefits of TIPS Surgery
TIPS reduces portal hypertension, controls variceal bleeding, improves ascites management, and decreases the need for repeated procedures.
- Minimally Invasive Approach: Small access site in the neck instead of open surgery, leading to less pain and faster recovery.
- Effective Relief from Portal Hypertension: Reduces pressure in the portal vein, preventing variceal bleeding and fluid accumulation in the abdomen or chest.
- Shorter Hospital Stay: Most patients are discharged within 1-3 days, depending on their overall health.
- Symptom Management: Helps manage refractory ascites, hepatic hydrothorax, and other complications of liver disease.
- Bridge to Liver Transplant: Can stabilize patients awaiting liver transplantation by controlling complications and improving overall condition.
- Improved Quality of Life: Patients experience relief from swelling, bleeding risk, and abdominal discomfort.
Risks of TIPS Surgery
Potential risks include bleeding, infection, hepatic encephalopathy, stent blockage, or contrast-related complications.
Cost of TIPS Surgery in India
The cost of TIPS surgery in India varies depending on the hospital, the complexity of the case, the type of stent used, and post-procedure care required. On average, the procedure costs between Rs. 1,50,000 to Rs. 4,50,000, with additional expenses for imaging, ICU stay, and follow-up treatments if needed.
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Transjugular Intrahepatic Portosystemic Shunt (TIPS)
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