Study of use of saphenoperitoneal shunts in intractable ascites

Background: Ascites is a common complication in patients with chronic liver disease. Ascites usually complicates chronic liver disease, and some patients with ascites are refractory to medical treatment. Recently, saphenoperitoneal shunt was described to treat this condition. This procedure avoids the insertion of a foreign expensive shunt into the circulation. Describe the experience with this procedure with some changes in the technique.Methods: A prospective study was performed on 8 patients with intractable ascites admitted to the surgical ward of Maharani Laxmi Bai Medical College during the period from November 1999 to April 2001. Eight patients with chronic liver disease and diuretic-resistant ascites underwent this procedure. The patients were classified by severity of liver disease as estimated from serum bilirubin and albumin values. Observations were present in tables, number and percentage using Microsoft excel.Results: Procedure performed in 8 patients and was successful 6 patients. Effective doses of diuretics required were decreased to one eighth of the preoperative dose over a median 3 months post- operative period. No patient with successful shunt needed postoperative paracentesis or re-hospitalization in a median follow-up of 8 month. No other complication was found except ascitic leakage.Conclusions: All patients, who had a successful shunt had symptomatic relief from ascites. Therefore the saphenoperitoneal shunt potentially offers all the benefits of peritoneovenous shunting without the disadvantage of using prosthetic material.

Patient with Liver Failure Presenting for Transjugular Intrahepatic Portosystemic Shunt

This chapter presents a case study of a 66-year-old man with a history of hepatitis C and cirrhosis complicated by intractable ascites who presents for an elective transjugular intrahepatic portosystemic shunt (TIPS) procedure. TIPS remains an important tool for the management of the complications of portal hypertension. Technical advances and clinical studies provide the evidence to define the best indications for the procedure. Patients who were successfully treated by TIPS still need regular follow up with a hepatologist. These patients remain at risk for development of other complications of cirrhosis such as hepatocellular carcinoma. This chapter discusses these issues and other concepts related to anesthetics for a liver transplant patient presenting for TIPS.

The influence of a peritoneovenous shunt for cirrhotic and malignant intractable ascites on renal function

Background Peritoneovenous shunts (PVS) are widely used for palliation of intractable ascites caused by peritoneal carcinomatosis (PC) or liver cirrhosis (LC). Some patients who need PVS have renal dysfunction. However, renal dysfunction is considered a relative contraindication. Therefore, it is important to assess renal function before PVS placement. Purpose To evaluate the relationship between PVS and renal function. Material and Methods Between October 2007 and July 2015, 60 patients (PC = 47; LC = 10; others = 3) underwent PVS placement for intractable ascites. Changes in estimated glomerular filtration rate (eGFR) and other adverse events (AEs) were retrospectively analyzed. Results Changes in eGFR before, one day after, and one week after PVS placement could be evaluated in 46 patients. The median eGFR before, one day after, and one week after was 56.5, 59.1, and 64.7 mL/min/1.73 m2, respectively ( P < 0.05). These values were 61.6, 72, and 67.1 mL/min/1.73 m2, respectively, in PC patients (n = 34; P < 0.05) and 28.5, 27, and 37.2 mL/min/1.73 m2, respectively, in LC patients (n = 10; P < 0.05). In 17 patients with moderate to severe renal dysfunction (eGFR < 45), these values were 23.4, 23.7, and 30.5 mL/min/1.73 m2, respectively. The most frequent AE was PVS catheter obstruction, which occurred in 12 patients (20.7%). Clinical disseminated intravascular coagulation occurred in six patients (10.3%) and caused death in three patients (5.2%). Conclusion PVS placement for intractable ascites is associated with various AEs. However, PVS appeared to promote renal function, especially in patients with renal impairment.