Sapheno-peritoneal shunting for treatment of resistant ascites

Abstract

INTRODUCTION: Prosthetic peritoneovenous shunts are useful to manage resistant ascites due to portal hypertension. However, they are expensive and not widely available. AIM : To assess the efficacy to direct sapheno-peritoneal shunting (SPS) in the treatment of resistant ascites due to portal hypertension. SETTING : University Medical and Surgical Units, Colombo North General Hospital. METHODS : Six male alcoholic cirrhotics (age range 39-68 years) with ascites resistant to diuretics and paracentesis were offered this procedure. Two had evidence of early encephalopathy. SPS was performed under general anaesthesia in 5 and spinal anaesthesia in one. Procedure consisted of division of the saphenous vein 5-6 cms distal to the saphenofemoral junction and connecting the proximal cut end to the peritoneal reflexion above the inguinal ligament. RESULTS : There was no surgical mortality. Control of ascites was considered satisfactory in 5 of the 6 patients (reduction in discomfort, abdominal girth, diuretic requirement and no further paracentesis necessary). The Childs grade improved in 3 of the 6 patients and remained unchanged in 3. One patient required repeated paracentesis, developed severe hepatic encephalopathy and died three months after surgery. Wound infection was seen in 3 patients and a temporary peritoneal fluid leak was seen in another 3. At the time of discharge from hospital Doppler ultrasound showed that the shunt was patent and EEC showed no evidence of encephalopathy in any-patient. CONCLUSION : Although our numbers are small, in the short-term, SPS appears to be useful and relatively safe for control of resistant ascites. It is appropriate for poor countries as an alternative to prosthetic shunts.