The role of denver perttoneo-venous shunt in management of patients with refractory ascites
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Introduction: Refractory ascites constitutes 15% of all patients suffer ing from ascites. It is associated tuith great morbidity, repeated hospitalization and poor quality of life. Recently . better understanding of pathophysiglogical changes associated with ascites that could be reversed by shunting of the ascetic fluid into the systemic circulation as well as the development in the peri-operative management that could overcome and prevent certain serious complications resulted in reappraisal of Denver shunt for treatment of refractory ascites. The aim of this study is to define those patients suffering from refracto ry ascites who can benefit from peritoneo-venous shunting of ascites us ing Denver shunt Methods: Thirty-five patients with refractory ascites were selected for peritoneo-venous shunt (P.V.Sj according to certain criteria indiuding: Pugh score <10, platelet count >70xlC^^/L. serum Jibrinogen >230mg/dl and micro-organism free ascetic fluid on culture. All patients had pre-operative tapping and partial replacement of as cetic fluid with lactated Ringer's solution into the peritoneal cavity. Results: Thirty-five patients (28 males and 7 females) with a mean age of 41 years had Denver shunts. A mean volume of 7.5 L of ascetic fluid was removed and replaced in half pre-operatively. Peri-operative mortali ty was 5.696 due to coagulopathy and septicaemia. One patient had con gestive heart failure and 2 patients had episodes of variceal bleeding . the mean hospital stay was 6 days and the mean follow-up period was18 months. The serum albumin level improved in 82.8% of patients with a mean rise of 0.8 gm/dl. The mean loss of weight due to ascetic fluid shunting was 6.5 kg associated with reduction of abdominal girth by a mean of 40% after one month. The shunt was functioning in lOO'^ of pa tients after 6 month. 94% after 12 months and 91% after 18 months. A questionnaire proved better quality of life after P.V.S. Conclusion: P.V.S is effective in palliation of refractory ascites. The out come is basically dependant on the functional hepatic reserve, hence proper selection of patients is of prime importance to get a favourable out come.