Transjugular intrahepatic portosystemic shunt for intractable posthepatectomy ascites

We report two cases of transjugular intrahepatic portosystemic shunt for control of intractable ascites after resection of cirrhotic livers. The first case was a 46-year-old male who had undergone right lobectomy of the liver for a small hepatocellular carcinoma. His liver function had recovered within a week after the operation, but ascites drainage of 1-4 L/day persisted for more than a month despite vigorous medical therapy. We performed transjugular intrahepatic portosystemic shunt on the 49th postoperative day and the pressure gradient between the right atrium and the left portal vein was reduced to from 21 mmHg to 6 mmHg. Thereafter, ascites became responsive to diuretic therapy and was well controlled without complication. Second case of a 54-year-old male patient who had undergone left lateral segmentectomy due to a small hepatocellular carcinoma presented intractable ascites of 1-3 L/day, which was also effectively controlled after transjugular intrahepatic portosystemic shunt performed on the 34th postoperative day, though there was an episode of hepatic encephalopathy stage 1. Based on our limited experience, hepatectomized patients suffering from prolonged intractable ascites despite a favorable profile of liver function may be candidates for transjugular intrahepatic portosystemic shunt with an acceptable risk of hepatic failure and procedure-related complication.