Peritoneal venous shunting for ascites: a 15-year perspective

Intractable ascites is an incapacitating condition for the patient and a difficult management problem for the physician. Three different shunts have been evaluated in 26 patients over a 15-year period and, on the basis of this experience, recommendations are made to avoid some of the technical problems with peritoneal venous shunts. Nine patients had a Hyde shunt, 12 had a LeVeen shunt, and five patients had a Denver shunt. Operation was performed only after failure of medical management during a 2-24-week period of hospitalization. Four patients had malignant ascites, two nephrogenic ascites, and the remaining 24 patients had ascites secondary to alcoholic liver disease. The type of shunt used did not appear to be critical, as the results were similar in the three groups. The morbidity rate of 57% (operative deaths and need for revision) and the fact that only 27% were alive after one year emphasize that improvements are desirable. Methods to avoid technical problems influencing malfunction of the device are stressed.