Saphenoperitoneal anastomosis for resistant ascites in patients with cirrhosis

Background: Restriction of salt intake and diuretics combined with repeated paracentesis has been the mainstay of managing longstanding ascites. Perit oneal-venous shunts have been employed in refractory ascites but are not wi thout complication. We evaluated an autologous reversed segment of proximal long saphenous vein anastomosed to the peritoneum in management of patient s with resistant ascites. Methods: Eleven patients (8 male, median age 48 years, range 37 to 68) with tense refractory ascites associated with cirrhosis of the liver and portal hypertension underwent saphenous vein-peritoneal anastomosis by rotating t he proximal vein cephalad which was anastomosed to peritoneum in the poster ior wall of the inguinal canal. Ten of 11 procedures were performed under g eneral anesthetic. Results: Thirty-day mortality was 1 patient. Morbidity included transient h epatic encephalopathy in 4 (36%), minor wound hemorrhage in 3 (27%), fluid leakage in 7 (64%), and wound infection in 7 (64%). Hospital stay (median) was 16 days (range 11 to 23). In the short term (median of 9 months) signif icant reduction in body weight and abdominal girth was seen in 9 (90%), 6 ( 60%) were not on diuretics while 3 (30%) continued to remain on reduced dos es of duiretic. Furthermore, 7 (70%) did not require paracentesis. At 2-yea r follow-up, 5 (45%) patients had died and 3 were lost to follow-up. The re maining 3 were all in active employment, 1 was off diuretics, and 2 were on reduced doses. All 3 patients maintained reduced body weights and abdomina l girths compared with preoperative values. Conclusions: Saphenous-peritoneal anastomosis appears a simple, safe, and e ffective method of achieving long-term control of refractory ascites. The u se of a biological shunt is an added advantage over prosthetic shunts for d rainage of ascitic fluid. (C) 2001 Excerpta Medica, Inc. All rights reserve d.