Clinical efficacy of transjugular intrahepatic portosystemic shunt created through left or right branches of the portal vein:A meta-analysis

Background and aim:Transjugular intrahepatic portosystemic shunt(TIPS)is a technique successfully used to treat portal hypertension and its complications.However,the choice of the branch,left(L)or right(R),of the portal vein resulting in a better outcome is still under debate.Therefore,this meta-analysis aims to evaluate which branch has a better curative effect on patients treated with TIPS.Methods:PubMed,EMBASE,Web of science,Cochrane Library databases,Wanfang database and CBM were used for our search in October 2019 and updated in June 2021.The following parameters were used in evaluation:overall mortality,hepatic encephalopathy,shunt dysfunction,variceal rebleeding and rate of postoperative ascites.Results:There were seven studies included.The sample size was 1940.A lower risk of mortality was observed in TIPS-L-treated patients compared with TIPS-R-treated ones(OR=0.65,95%CI=0.50-0.85,p=0.002).A lower risk of shunt dysfunction was observed in TIPS-L-treated patients compared with TIPS-R-treated ones(OR=0.53,95%CI=0.33-0.87,p=0.01).And the TIPS-L group had a significantly higher hepatic encephalopathy-free rate than the TIPS-R group(OR=0.59,95%CI=0.44-0.78,p=0.0002).However,the rate of rebleeding(OR=0.75,95%CI=0.55-1.03,p=0.07)and incidence of postoperative ascites(OR=1.14,95%CI=0.86-1.51,p=0.38)was not statistically significant between the two groups.Conclusions:Based on the currently available evidence,the technique of TIPS through the left branch of the portal vein can significantly reduce the occurrence of overall postoperative mortality,hepatic encephalopathy and shunt dysfunction.