Surgery for portal hypertension and transjugular intrahepatic portosystemic shunts in Germany: results of a national survey

A national survey was conducted to determine the role of portosystemic shunt surgery and transjugular intrahepatic portosystemic shunt (TIPS) in Germany. A questionnaire was mailed to 1324 surgical units at 1273 hospitals, and 941 responses (74 %) were received. Interventional endoscopy for variceal bleeding is carried out predominantly (73 %) in medical departments. From 1992 to 1997 the annual number of surgical shunts dropped from 253 to 120, whereas the respective numbers of TIPS increased from 202 to 920. In this 6-year period a total of 1042 shunts and 3575 TIPS were reported by 109 and 64 centers, respectively. TIPS was applied mainly in university hospitals (88.9 %), whereas shunt surgery was more broadly used in non-university hospitals (58.8 %). Clearly, prospective randomized comparisons of TIPS and surgical shunts are needed to reveal which treatment is best in patients with variceal bleeding stratified for mortality risk and stage of liver disease. However, the decreasing number and experience with shunt surgery may impede such studies. Probably, liver transplant centers which currently do only 41.2 % of shunt procedures are most familiar with surgery in portal hypertension and are therefore most appropriate to maintain quality and expertise in this palliative and demanding branch of surgery.