Background and Aims: The common treatment methods for cavernous transformation of the portal vein (CTPV) include medical treatment and surgery, while interventional surgery is not usually used in this field, and this disease has long been considered to be a contraindication for transjugular intrahepatic portosystemic stent-shunt (TIPSS). With the improvement of technology and the upgrading of relevant operating devices in recent years, TIPSS is increasingly carried on in CTPV patients. However, the implementation of TIPSS for CTPV patients is not widespread at present, and it is only conducted in some vascular intervention centers with extensive experience. Meanwhile, there is also a lack of evidence-based data to prove its application value. This study was conducted to evaluate the feasibility, efficacy and safety of application of TIPSS in CTPV patient through a Meta-analysis, so as to obtain evidence-based information for clinical decision-making. 
Methods: The relevant literature was collected by searching a number of national and international database. The retrieval time was limited from the inception of each database to February 2020. After extraction of the relevant data, the success rate of surgery, the incidence of major complications, porto-systemic pressure gradient (PPG) before and after surgery, postoperative rebleeding rate, incidence of postoperative hepatic encephalopathy, 12-month stent patency rate and 12-month survival rate were recorded as clinical outcome parameters. Meta-analysis of the data was performed by RevMan 5.1 software. Stata 14 software was used for quantitative analysis of publication bias detection.
Results: Nine studies were included based on inclusion and exclusion criteria, involving a total of 188 CTPV patients who underwent TIPSS treatment. The pooled results of Meta-analysis showed that operation success rate was 77% (95% CI=63%–87%, I2=67%, P=0.000 5), the incidence of major surgical complications was 22% (95% CI=11%–40%, I2=59%, P=0.004), the PPG was significantly reduced after operation (WMD=13.19, 95% CI=11.86–14.52, I2=58%, P<0.000 01), the rebleeding rate was 12% (95% CI=7%–21%, I2=0%, P<0.000 01), the incidence of postoperative hepatic encephalopathy was 17% (95% CI=11%–25%, I2=0%, P<0.000 01), the 12-month patency rate of stent was 81% (95% CI=73%–86%, I2=0%, P<0.000 01), and the 12-month survival rate was 89% (95% CI=81%–94%, I2=16%, P<0.000 01).
Conclusion: TIPSS is feasible, effective and safe in CTPV patients. However, the successful implementation of this technique cannot be achieved without relevant experience and specialized skills of the surgeon. It is also necessary to fully evaluate and weigh the risks and advantages of the operation based on the relevant preoperative examinations and the patient's condition, strict consideration of indications, and appropriate treatment plan making, so as to maximize the benefits of the target patient group. It is expected that TIPSS treatment will become a routine treatment for suitable CTPV patients, and a relatively unified consensus and operating standards will be reached in the future. At present stage, more large sample, multicenter randomized controlled trials are urgently needed to fully compare various factors to guide clinical decision-making in this field.