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Modified saphenous-peritoneal shunt in refractory ascites: new technique
Jia-Hui Chen1, Hsiao-Dung Liu, Jyh-Cherng Yu
1Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan.
Background:
Refractory ascites is a serious complication for patients with decompensated liver cirrhosis. Saphenous-peritoneal shunting is a possible surgical treatment for its relief, but tends to lead to higher groin infections. The purpose of the present paper was to determine whether a modified procedure could resolve the problem and offer potential advantages over a peritoneo-venous shunt.
Methods:
Sixteen patients with refractory ascites who received modified saphenous-peritoneal shunts were studied. Clinical data such as bodyweight, abdominal girth, indocyanine green 15-min retention rate (ICG-15), serum bilirubin concentrations, Child-Pugh Score, creatinine clearance (C(Cr)), daily urinary output, urine sodium (U(Na)) and operative complications were recorded before, and 3 months after, surgery.
Results:
Three months after the operation, the urinary output, nutritional status and Child-Pugh scores had improved, but ICG-15 and total bilirubin output had not changed significantly. The C(Cr), U(Na) bodyweight and abdominal girth tended to decrease, but not significantly. No groin infections were noted following this procedure.
Conclusions:
This modified procedure not only improved the nutritional status of cirrhotic patients with refractory ascites but also improved their quality of life. Infections and obstructions decreased in the short term. However, long-term follow up is mandatory. This new technique requires more practice and experience.
