[Use of the Leveen shunt in the treatment of clinically intractable ascites].
From January 1978 to August 1987, 21 patients received a peritoneovenous shunt using the Le Veen valve (LVV). The indications criteria were the long-term diuretic therapy failure (mean time = 24.4 months) or resistence to medical therapy during hospital internment. The 21 patients underwent 36 surgeries, being 4 valve position review and 11 changes of LVV. The mean age was 51.6 years. Fifteen patients had alcoholic cirrhosis, 3 postnecrotic cirrhosis, one Budd-Chiari syndrome, one mansoni Schistosomiasis, and one malignant ascites. Ten were Child B and 9 Child C patients. Eight patients with history of previous esophageal varices bleeding (EVB) underwent endoscopic sclerotherapy (EE) before LVV implantation. Seven patients died in the early postoperative period (3 Child B and 4 Child C patients). Three patients died due to EVB and the others as consequence of hepatic failure (one), cardiac insufficiency (one), sepsis (one), and bronchopneumonia (one). The mean follow-up was 19.9 months (1-61). Early LVV occlusion occurred in 4 patients and late valve occlusion in others 4 patients. The LVV changes were done at ambulatorial preceeding. Ten patients (47.6%) died in late follow-up and in these cases death was related to the main disease course. It is concluded that: 1) LVV is a useful therapy in patients with intractable ascites, since it is not the terminal manifestations of disease; 2) early mortality is related to liver function and late mortality to main disease course; 3) ascitic patients with EVB should undergo endoscopic sclerotherapy before LVV implantation.
D'Albuquerque
L A
LA
Serviço de Fígado do Instituto de Cirurgia do Aparelho Digestivo e Coloproctologia, Hospital da Beneficência Portuguesa de São Paulo.
de Oliveira e Silva
A
A
Genzini
T
T
de Miranda
M P
MP
Arab-Fadul
R
R
Gama-Rodrigues
J J
JJ
D000206:Actuarial Analysis; D001201:Ascites / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery*; D008297:Male; D010536:Peritoneovenous Shunt / Q000401:mortality; D011300:Preoperative Care
Uso da válvula de Le Veen no tratamento da ascite clinicamente intratável.