Comparison of the impact of shunting the left versus right portal vein branch during TIPS on the postoperative overt hepatic encephalopathy: An updated Systematic Review and Meta-Analysis

Background Hepatic encephalopathy (HE) after undergoing transjugular intrahepatic portosystemic shunt (TIPS) persists as an important iatrogenic complication, occurring in 10–50% of patients. The potential reduction in hepatic encephalopathy (HE) risk when shunting the left (LPV) versus right portal vein (RPV) branch during transjugular intrahepatic portosystemic shunt (TIPS) remains controversial. To address this question, we conducted an updated systematic review and meta-analysis limited to high-quality study designs. Methods We performed a systematic search of PubMed, Embase, and Cochrane, identifying randomized controlled trials (RCTs) and propensity score–matched (PSM) cohort studies comparing LPV versus RPV branch shunting during TIPS. The primary outcomes were overt HE and shunt dysfunction; the secondary outcome was technical success. Random-effects meta-analysis using REML estimation and Hartung-Knapp adjustment was used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs). Results LPV shunting was not associated with a significant reduction in overt HE (RR 0.68; 95% CI 0.39–1.18; p=0.122) or shunt dysfunction (RR 1.04; 95% CI 0.64–1.67; p=0.844). Group technical success was similarly successful. In fixed-effect sensitivity analyses, LPV was associated with a marginal reduction in HE (RR 0.72; 95% CI 0.53–0.97; p=0.031), but results were inconsistent across models. Conclusion LPV shunting during TIPS does not significantly reduce overt HE, shunt dysfunction or improve technical success compared with RPV shunting. The selection of portal vein branch should be based on anatomy and the operator's ability. Further adequately powered multicenter RCTs with baseline HE stratification are warranted.