Background Variceal haemorrhage is a major cause of mortality and morbidity in patients with portal hypertension. Transcutaneous intrahepatic portosystemic shunt (TIPSS) is a procedure which is widely used in adults with limited experience in children.
Objectives The aim of this study is to analyse the use of pre- and post-operative laboratory results as predictors for TIPSS failure in the given sample.
Methods This is a retrospective study of children who underwent TIPSS from 1998 to 2013. Data were obtained within 1 month before TIPSS placement. The variables are shown in (Table 1). Failure of TIPSS was defined as requirement of revision within 36 months after the procedure. Patients were divided into two groups post-operatively according to the procedure success; those who did not require revision within 36 months after procedure were considered to have successful TIPSS, while those who needed revision within 36 months after procedure had a failed TIPSS procedure.
Results A total of 10 children (7 females) underwent TIPSS. The primary indication was variceal haemorrhage in all the patients with different diagnoses (Table-1). Congenital Hepatic Fibrosis was the most common aetiology (50%). Three patients (30%) needed revision in a mean of 24.2 month post-procedure. 7 patients (70%) did not require revision 36 month post procedure, with a mean follow up of 60.5 month.
Pre-operative high serum alkaline phosphatase (ALP) was associated with TIPSS failure (p value =0.027) and thus, can be used as a pre-operative predictor for failed TIPSS. Other variables did not show significant association with TIPSS procedure including patients age and weight.
Conclusion This study involves the association of multiple variables with TIPSS outcomes in children. ALP showed a relative association as a predictor to TIPSS failure. Further studies are needed with a larger sample.