Continuous peritoneal drainage of large-volume ascites

Area of Science:

• Hepatology
• Gastroenterology
• Medical Devices

Background:

• Increasing prevalence of cirrhosis necessitates effective management of refractory ascites.
• Large-volume paracentesis is a common therapy for diuretic-resistant ascites in non-transplant candidates.
• Child Class-C cirrhosis patients often present with significant ascites volume.

Purpose of the Study:

• To evaluate the safety and efficacy of continuous peritoneal drainage for large-volume ascites.
• To assess outcomes in patients with Child Class-C cirrhosis undergoing this procedure.
• To determine the impact on ascites recurrence and patient well-being.

Main Methods:

• Recruited patients with Child Class-C cirrhosis and no spontaneous bacterial ascites.
• Conducted thorough medical evaluations, including abdominal CT to rule out hepatoma.
• Utilized the Seldinger technique for pericardiocentesis catheter placement and continuous gravity drainage for up to 72 hours.
• Monitored weight, fluid removal volume, and performed pre- and post-procedure laboratory analyses.

Main Results:

• HCV and alcoholic liver disease were the most common etiologies.
• Average drainage duration was 2.5 days, with 13.3 liters of fluid removed.
• No significant changes in serum creatinine or ascitic fluid cell counts were observed.
• Adverse effects were minimal, including mild discomfort at the insertion site or local abdominal pain.
• Two patients developed small abdominal wall hematomas; no peritoneal hemorrhage, infection, or renal dysfunction occurred.

Conclusions:

• Continuous large-volume peritoneal drainage is a safe and effective treatment for ascites.
• Limiting drainage to 72 hours prevents ascitic fluid contamination and infection.
• The procedure effectively reduces the interval between subsequent paracentesis procedures.