Peritoneovenous Shunt for Refractory Ascites

Bernhoft, Robin A.; Way, Lawrence W.

doi:10.1001/archsurg.1982.01380290081014

Cited by 32 publications

(12 citation statements)

References 14 publications

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“…These patients were further classified into on the basis of S. albumin & S. bilirubin. There was no postoperative death which is comparable to the previous study of Bernhoft et al 15 In our study most of cases were operated under spinal, though it may be performed under local anaesthesia. Whereas, shunt was performed in all the 35 patients under local anaesthesia.…”

Section: Resultssupporting

confidence: 91%

“…Whereas, shunt was performed in all the 35 patients under local anaesthesia. 15 Smajda and Franco, 1985 in his study of 140 patients with LeVeen shunt, doses of diuretics required were furosemide 80 mg/d for 2-6 months. 19 Furthermore, in the study of Vadeyar et al with saphenoperitoneal shunt 7 patients who had successful surgery, median dose of diuretic was reduced from a median dose of 300 mg/day to 50mg/day in the 3 months after operation.…”

Section: Resultsmentioning

confidence: 99%

“…were LeVeen shunts and one was a Denver shunt. 15 There were 24 male and 11 female subjects; the mean age was 50.1 years with age ranging from 10 months to 67 years. In our study total of 8 patients underwent saphenoperitoneal shunt.…”

Section: Resultsmentioning

confidence: 99%

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Study of use of saphenoperitoneal shunts in intractable ascites

Yadav¹,

Verma²,

Rai

2019

Int Surg J

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Background: Ascites is a common complication in patients with chronic liver disease. Ascites usually complicates chronic liver disease, and some patients with ascites are refractory to medical treatment. Recently, saphenoperitoneal shunt was described to treat this condition. This procedure avoids the insertion of a foreign expensive shunt into the circulation. Describe the experience with this procedure with some changes in the technique.Methods: A prospective study was performed on 8 patients with intractable ascites admitted to the surgical ward of Maharani Laxmi Bai Medical College during the period from November 1999 to April 2001. Eight patients with chronic liver disease and diuretic-resistant ascites underwent this procedure. The patients were classified by severity of liver disease as estimated from serum bilirubin and albumin values. Observations were present in tables, number and percentage using Microsoft excel.Results: Procedure performed in 8 patients and was successful 6 patients. Effective doses of diuretics required were decreased to one eighth of the preoperative dose over a median 3 months post- operative period. No patient with successful shunt needed postoperative paracentesis or re-hospitalization in a median follow-up of 8 month. No other complication was found except ascitic leakage.Conclusions: All patients, who had a successful shunt had symptomatic relief from ascites. Therefore the saphenoperitoneal shunt potentially offers all the benefits of peritoneovenous shunting without the disadvantage of using prosthetic material.

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Section: Resultssupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

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Study of use of saphenoperitoneal shunts in intractable ascites

Yadav¹,

Verma²,

Rai

2019

Int Surg J

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“…thors reported 5 long-term survivors of 9 patients with HRS treated with the PVS [79]. Other reports that followed [80][81][82][83][84][85][86][87] (Table 9) claimed long-term survival rates approaching 40%. Nevertheless, careful scrutiny of the reported cases reveals that diagnosis of HRS was frequently inadequately documented, and that many of the original cases were included in subsequent series [88,89].…”

Section: Treatment Of Hrs With Invasive Proceduresmentioning

confidence: 99%

Management of Renal Complications of Liver Disease

Epstein

Pérez

Oster

1988

J Intensive Care Med

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Included among the most important renal complica tions of liver disease is progressive sodium retention leading to the formation of edema and ascites and the hepatorenal syndrome (HRS). When ascites is refractory to conventional treatment, the use of invasive proce dures such as reinfusion or dialytic ultrafiltration of as cites or the peritoneovenous shunt may be indicated. The possibility that continuous arteriovenous hemo filtration may be useful in removing fluid in patients who would not otherwise tolerate traditional hemodialysis has, because of its recent availability, been raised. Ther apy of HRS continues to be one of the most intriguing and vexing problems in clinical medicine. The use of hemodialysis with polyacrylonitrile membranes may be helpful in certain patients with HRS, especially in those with acute reversible liver injury. Although the peri toneovenous shunt has been reported to correct the renal functional disturbance, the results of the only two controlled studies available are inconclusive. Liver disease is frequently accompanied by a variety of alterations in renal function and electrolyte me tabolism [1]. These complications of liver disease range in severity from the clinically unimportant to problems requiring prompt and vigorous thera peutic intervention. In the present review, empha sis is placed on the management of the abnor malities of renal sodium handling and on acute intrinsic renal failure (ATN) and the hepatorenal syndrome (HRS), which often supervene in patients with severe liver disease. The reader is referred to Epstein [1,2] and Perez and colleagues [3] for more detailed expositions of the use of dialysis and ultrafiltration in treating renal complications of liver disease.

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“…Absolute contraindications to the procedure include uncorrectable bleeding diathesis, sepsis, bacteremia, end-stage renal disease requiring dialysis, and active pulmonary or pleural infection. 14 15 16 17 18 19 20 21 22 23 Severe chronic kidney disease, central venous stenoses, congestive heart failure, and septated pleural effusions are relative contraindications to shunt placement. 14 15 16 17 18 19 20 21 22 23…”

Section: Patient Selectionmentioning

confidence: 99%

Pleurovenous Shunt Placement for the Management of Nonmalignant Pleural Effusion

Awwad

Berman

Minocha

2022

Semin intervent Radiol

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Therapeutic thoracentesis is a first-line therapy in the management of patients with medically refractory, nonmalignant pleural effusion. However, when required in short intervals, serial thoracenteses can lead to increased procedure-related complications and negatively impact quality of life. Alternative treatment options vary depending on the etiology of fluid accumulation. Hepatic hydrothorax secondary to cirrhosis is a common cause of medically refractory pleural effusion encountered by interventional radiologists. In select patients in whom surgical pleurodesis, transjugular intrahepatic portosystemic shunt placement, and/or tunneled pleural catheter placement cannot be performed or provide inadequate relief, implantation of a pleurovenous (Denver) shunt may assist in palliation. The Denver shunt system allows decompression of pleural fluid into the central venous circulation by utilizing unidirectional valves and a manually operated subcutaneous pump. Though limited reports have described favorable technical and clinical success, more research is required to determine the safety and efficacy of this procedure. This article discusses pleurovenous shunt placement, postprocedure shunt evaluation, and potential associated complications.

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Peritoneovenous Shunt for Refractory Ascites

Cited by 32 publications

References 14 publications

Study of use of saphenoperitoneal shunts in intractable ascites

Study of use of saphenoperitoneal shunts in intractable ascites

Management of Renal Complications of Liver Disease

Pleurovenous Shunt Placement for the Management of Nonmalignant Pleural Effusion

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