TREATMENT OF PATIENTS WITH CIRRHOSIS AND REFRACTORY ASCITES USING LEVEEN SHUNT WITH TITANIUM TIP - COMPARISON WITH THERAPEUTIC PARACENTESIS

It has recently been suggested that insertion of a titanium tip at the venous end of the LeVeen shunt drastically reduces the rate of shunt obstruction. To assess whether the LeVeen shunt with titanium tip impr oves the results obtained with therapeutic paracentesis, 81 patients w ith cirrhosis and refractory ascites were randomly assigned to therapy with paracentesis plus intravenous albumin (42 patients) or LeVeen sh unt with titanium tip (39 patients). If patients were readmitted for a scites during follow-up, those in the first group were treated with pa racentesis, and those in the LeVeen shunt group by the insertion of a new valve or a new shunt if obstruction was demonstrated. During first hospitalization, both treatments were equally effective in removing a scites. Complications were similar in both groups except for a higher rate of severe bacterial infection in the LeVeen shunt group. The mean duration of hospitalization was shorter in the paracentesis group tha n in the shunt group. During follow-up, the total number of readmissio ns and the number of readmissions for ascites were higher in the parac entesis group than in the shunt group (252 vs. 99, P < .001; and 193 v s. 43, P < .001, respectively). The total time in hospital, however, w as similar (38 +/- 38 vs. 39 +/- 43 days, P = NS). Three patients had obstruction of the shunt during first hospitalization and 14 patients had a total of 22 obstructions during follow-up. Long-term survival wa s similar in both groups. The insertion of a titanium tip at the venou s end of the LeVeen shunt does not prevent obstruction. The LeVeen shu nt with titanium tip does not provide significant improvement over the rapeutic paracentesis in the management of cirrhotic patients with ref ractory ascites.