Peritoneovenous shunting for cirrhotic versus malignant ascites

The use of the peritoneovenous shunt in patients with cirrhosis is associated with a significantly higher complication rate than in patients with malignant ascites. Since many patients subsequently died due to the complications of shunt placement and the efficacy has never been clearly established by a randomized trial, it is difficult to recommend a procedure which may shorten the already brief life expectancy of the patient. We conclude that for the patients with ascites due to cirrhosis, the peritoneovenous shunt should be reserved for a carefully selected group, such as those patients with pending rupture of a hernia. However, for the patient with malignant ascites, the relatively low complication rate of peritoneovenous shunt placement and the lack of an adverse effect on survival time indicates that use of this successful palliative technique seems warranted in selected patients.