Saphenoperitoneal shunts for patients with intractable ascites associated with chronic liver disease

Background: Ascites is a common complication in patients with chronic liver disease. Some patients are resistant to diuretics and need therapeutic par acentesis on a regular basis. This is inconvenient in the long term and als o has resource implications. Alternatively, these patients may be treated b y peritoneo-venous shunts, which require insertion of a foreign body into a central vein and are prone to occlusion. A new technique for peritoneoveno us shunting without the use of foreign material is described. Methods: Eight patients with chronic liver disease and diuretic-resistant a scites underwent this procedure. During operation, the long saphenous vein was divided at the mid-thigh level and inverted towards the inguinal canal, where it was anastomosed directly to the peritoneum at the internal inguin al ring using non-absorbable suture material. Results: Seven patients had successful shunt formation; the remaining patie nt had to have the shunt removed because of ascitic leakage. In those who u nderwent successful shunt formation, the need for paracentesis and the dose of diuretic was significantly reduced over a median follow-up of 8 months. Hospital stay in the month after discharge was significantly less than tha t in the month before operation. Three patients died during follow-up from causes unrelated to the operation. One patient underwent successful liver t ransplantation. Conclusion: This stud, suggests that saphenoperitoneal shunting is potentia lly a safe and effective therapy for patients with diuretic-resistant ascit es. It retains the benefits of peritoneovenous shunting without the adverse effects of insertion of foreign material.