Can a laparoscopic surgery be an alternative to transjugular intrahepatic portosystemic shunts (TIPS) for the treatment of portal hypertensive bleeding?

We read with great confusion the guidance written by Garcia-Tsao et al.(1).In the practice guidance developed by the American Association for the Study of Liver Diseases(AASLD),there is no trail of surgical operation for the treatment of portal hypertensive bleeding in cirrhosis at all.However,it is well known that surgical shunts played an important role in this setting before the emergence of transjugular intrahepatic portosystemic shunts(TIPS),existing studies have shown that surgical shunt still has better long-term patency and survival than TIPS(2),and surgical portoazygous devascularization is still considered as the most direct and effective way of hemostasis in some countries(3).