Minimally Invasive Solutions for Cirrhosis
Cirrhosis (or scarring of the liver) can be caused by many things including diet, alcohol, and certain infections. One of the liver’s jobs is to filter the blood coming from the bowels and spleen before the blood returns to the circulation of blood throughout the body. When there is scarring in the liver, it is harder for the blood to pass through creating high pressure in the veins (“portal veins”) taking blood from the bowels and spleen. This is called “portal hypertension.” It can cause fluid to accumulate in the belly (“ascites”) and/or around the lungs. It can also cause abnormal veins to form called “varices” that re-route the blood to bypass the liver. These varices are fragile and can rupture causing life threatening bleeding. They also allow the unfiltered blood to bypass the liver and can cause confusion (“hepatic encephalopathy”).
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
TIPS is a procedure where a tunnel is made through the liver to allow some blood to bypass the liver through the tunnel or shunt. This helps relieve the build up of pressure causing the fluid to accumulate and varices to form and bleed. It is performed through a pinhole in the neck. The main alternatives are having the fluid drained regularly or trying to control the bleeding varices with medications and bands to block them. However, TIPS tends to be most effective and improves the life expectancy of people with cirrhosis.
What are the risks and recovery?
Although TIPS is a minimally invasive procedure, it has a ~3% chance of a major complication such as causing liver failure, heart failure, major bleeding, and even death. This is lower than many surgeries but worth considering. Most people spend the night after in the hospital for monitoring before going home. It can cause some temporary abdominal pain and worsen confusion, so your liver doctor may need to adjust your medications afterwards.
tRANSVENOUS oBLITERATION
Some people are too sick or do not have good enough liver function to tolerate a TIPS. Transvenous obliteration is a minimally invasive procedure to destroy varices causing bleeding or confusion. This can be done through a pinhole at the base of the neck or top of the thigh or through the side into the liver. It tends to be a “plan B” because it can worsen the pressure in the portal veins causing more varices to form or more fluid to accumulate in the belly and around the lungs. Sometimes the varices can be destroyed by a gastroenterologist with a scope but this is not quite as effective.
What are the risks and recovery?
This is a generally safe procedure where you can go home the same day, but often this procedure is done for people already admitted to the hospital. Some people have a mild fever, pain, or blood in the urine that goes away in a few days. Major complications such as stroke, worsening bleeding, or damage to the liver or kidneys are very rare.
Partial Splenic Embolization
Another issue with cirrhosis is causing the spleen to get large and start destroying things in the blood such as platelets. This is called “hypersplenism.” Often you still have enough platelets to not cause a problem, but some people have severe enough hypersplenism to have problems. To help with this, the blood flow to part of the spleen can be blocked off, causing that part of the spleen to die and decreasing the spleen’s function to a more normal level. The other alternative would be removing the spleen entirely, but this is a major surgery and the spleen is an important organ for your immune system.
What are the risks and recovery?
This is a generally safe procedure but does require at least one if not a few days in the hospital. It tends to cause a lot of pain for a few days, so many people stay in the hospital to have access to medications to keep them comfortable while they recover. Other risks include infection.