[Role of surgery in the treatment of refractory ascites in cirrhotic patients].
Ascites, generally directly reflecting portal hypertension, is the commonest cause of hospitalisation in patients with cirrhosis. In almost 10% of patients with ascites, optimal medical treatment combining bed rest, salt and water restriction, and diuretic treatment, is unable to induce sodium excretion and decrease the volume of the ascites, corresponding to the definition of refractory ascites. In other cases, it is the treatment of ascites itself (salt and water restriction and diuretics) which induce complications: water and electrolyte disturbances, functional renal failure, encephalopathy, the development of which also corresponds to refractory ascites. The therapeutic armamentarium for the management of refractory ascites remains varied, with the use of aspiration of ascites with compensation, peritoneovenous shunts, transhepatic or surgical porto-systemic anastomoses, and finally, liver transplantation. At the present time, each therapeutic measure must be taken while keeping in mind the possibility of subsequent liver transplantation and the potential risk of compromising liver transplantation by inappropriate treatments. In this context, the authors review and analyse the respective places of the various therapeutic modalities in the management of refractory ascites in cirrhotic patients.
Borie
D C
DC
Service de Chirurgie Digestive, Hépato-Biliaire et de Transplantation Hépatique, Groupe Hospitalier Pitié-Salpêtrière, Paris. dominique.borie@psl.ap-hop-paris.fr
Vaillant
J C
JC
Breton
S
S
Hannoun
L
L
D001201:Ascites / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016001:Confidence Intervals; D004232:Diuretics / Q000627:therapeutic use; D004322:Drainage; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D016031:Liver Transplantation; D010536:Peritoneovenous Shunt; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011677:Punctures; D013997:Time Factors
D004232:Diuretics