title: Persistent ascites can be effectively treated by peritoneovenous shunts.
abstract: OBJECTIVE
  The aim the study was to review our experience and determine the effectiveness of peritoneovenous shunts in the management of persistent ascites.
  
  
  METHODS
  A retrospective review of all patients who had a peritoneovenous shunt inserted for persistent ascites in our institution over 32 years (1977-2010) was performed.
  
  
  RESULTS
  Thirty-one peritoneovenous shunts were inserted into 25 patients. Records from 22 were available. Median age was 34 months (range, 1 month-12 years), with median duration of ascites of 1.75 months (range, 3 weeks-2.5 years). Sixteen had previous abdominal surgery, whereas one had previous thoracic surgery. Other underlying pathologies included hepatitis (n = 2), lymphohistiocytosis, lymphatic hypoplasia, and carcinomatosis. One was regarded as idiopathic. Previous management consisted of paracentesis (n = 15), dietary modification (n = 11), diuretics (n = 9), and total parenteral nutrition (TPN) (n = 4). One underwent fetal drainage of ascites. No intraoperative complications occurred. Eight (36%) had postoperative complications, including shunt occlusion (n = 2), pulmonary edema (n = 2), infection (n = 2), and wound leakage (n = 1). One developed a varix following shunt removal. The ascites resolved after shunting in 20 (91%) of the 22 children. Four died from their underlying pathology. In children with malignancy, the shunt allowed prompt resumption in treatment schedule.
  
  
  CONCLUSIONS
  This represents the largest series of children receiving peritoneovenous shunt for persistent ascites. It is a safe and effective treatment which should be considered early.
authors.affiliation: Great Ormond Street Hospital and UCL Institute of Child Health, London WC1N 3JH, United Kingdom.
authors.forename: Nisha
authors.initials: N
authors.lastname: Rahman
authors.forename: Paolo
authors.initials: P
authors.lastname: De Coppi
authors.forename: Joe
authors.initials: J
authors.lastname: Curry
authors.forename: David
authors.initials: D
authors.lastname: Drake
authors.forename: Lewis
authors.initials: L
authors.lastname: Spitz
authors.forename: Augustino
authors.initials: A
authors.lastname: Pierro
authors.forename: Edward
authors.initials: E
authors.lastname: Kiely
mesh_terms: D001201:Ascites / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010536:Peritoneovenous Shunt / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome