Denver peritoneovenous shunt in the management of refractory ascites due to chronic liver diseases: impact of patients selection on its outcome.
Forty four patients with refractory ascites due to chronic liver diseases that fulfilling the inclusion criteria of selection were divided into 2 groups. The first group (GI, n=24) was subdivided into 2 subgroups according to degree of liver condition; GIa (n=11) with Child-Pugh class B and GIb (n=13) with early class C. The patients were subjected to P-V shunt (Denver group). Similarly, patients in the second group (GII, n=20) were divided into 2 subgroups GIIa (n=10) & GIIb (n=10) respectively and treated by the repeated tapping and albumin infusion (control group). Postoperative results revealed a significant increase in urine out put (P<0.001), decrease in abdominal girth (P<0.01) and body weight (p<0.01) with more patients fitness and satisfaction than in controls. Postoperative complications were more in GIb. Ascites recurrence occurred in 3 (23%) patients in GIb due to severe infection (2 cases) and irreversible shunt obstruction (1 case) and without recurrence in GIa. So, Denver P-V shunt offers a good palliation in such patients, but its use is more justified in selected cases.
Abbas
Mohamed
M
Department of Surgery, Theodor Bilharz Research Institute, Imbaba P.O.B. 30, Egypt. rabbas@sedo.org
El Damarawy
Mervat
M
Seyam
Moataz
M
Awad
Alaa
A
Madkour
Mona Ezzat
ME
Salah
Mohamed
M
D001201:Ascites / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010536:Peritoneovenous Shunt / Q000379:methods*; D011183:Postoperative Complications; D012720:Severity of Illness Index; D016896:Treatment Outcome