Faculty of Medicine.
Zaggazig University.. Egypt
Introduction: Refractory ascites constitutes 15% of all patients suffering
from ascites. It is associated with great morbidity, repeated hospitalization
and poor quality of life. Recently, better understanding of pathophysiological
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 pen-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 refractory
ascites who can benefit from peritoneo-venous shunting of ascites using
Denver shunt.
Methods: Thirty-five patients with refractory ascites were selected for
peritoneo-venous shunt (P. V.5) according to certain criteria including:
Pugh score <10. platelet count >70z109 / L. serum fibrinogen >230mg/ di
and micro-organism free ascetic fluid on culture.
All patients had pre-operative tapping and partial replacement of ascetic
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 mortality
was 5.6% due to coagulopathy and septicaemia. One patient had congestive
heart failure and 2 patients had episodes of variceal bleeding.
the mean hospital stay was 6 days and the mean follow-up period was 18 months. The serum albumin level improved in 82.896 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 100% of patients
after 6 month. 94% O'er 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 outcome
is basically dependant on the functional hepatic reserve, hence
proper selection of patients is of prime importance to get a favourable outcome. |
