Our experiences with saphenoperitoneal shunts in the treatment of intractable ascites

Because of significant expenses and complication rates of traditional pumps (LeVeen, Denver, Agishi) used in the surgical treatment of refractory ascites a simple and cheap operative method has to be found. In saphenoperitoneal shunts the one-way flow is maintained by biologically given double saphenous valves. In our department 11 saphenoperitoneal shunts have been performed on 9 patients (2 female, 7 male) in the past one and a half years. Their ascites have been associated with cirrhosis of the liver (secondary to aethylism in 8, to HBV infection in 1). During the follow-up period significant reduction in body weight and abdominal girth, and increase in diuresis with standard diuretics were seen in 6 patients. The minor complications (3 seromas, 3 hematomas, 2 cellulitis) have been self-limiting in general. In the presence of major complications (1 peritoneal reflux, 1 severe hypoproteinaemia, 3 shunt occlusion) interventions were needed several times. In one of the occlusions contralateral fistula was created with PTFE prosthesis implantation, in another case desobliteration happened with a silicone drain left in the shunt. The saphenoperitoneal shunts could improve quality of life significantly in successful instances with minimal negative operative effects without the adverse effects of insertion of foreign material.