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Invited Commentary

Robert Shields, MD, DSc
Arch Surg. 1997;132(6):632. doi:10.1001/archsurg.1997.01430300074015.
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For decades, medical and surgical hepatologists have pursued the Holy Grail of reduction in portal pressure, combined with an absence of complications and side effects. The radiologists have joined this elusive hunt with the development of TIPS. As usual in this field, early study results were most promising with apparently good control of bleeding. Technically, the procedure was demanding, but the technique became less traumatic and of shorter duration than the available invasive surgical procedures. Subsequently, in several uncontrolled large series and in smaller randomized control trials, much higher rebleeding rates were reported and the incidence of encephalopathy and liver failure gradually approached that found after surgical portosystemic shunts. The article by Tyburski et al presents a long-term study of a group of patients typically found in Western society, ie, with severe liver disease, mainly alcoholic in origin. In addition, the patients already had been selected in so far as


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