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This study was aimed to determine the effectiveness of peritoneovenous shunting with the LeVeen valve in relieving resistant ascites, to identify renal hemodynamic changes caused by the shunt, and to recognize complications of the shunting procedure. Six patients with ascites unresponsive to sodium and water restriction, bed rest, and administration of diuretics received peritoneovenous shunts. All six had considerable or complete resolution of ascites. Three patients, followed from 41 to 62 weeks, have had improvement in their nutritional status with 10%, 32%, and 32% increases in their daily creatinine excretion, indicating comparable increases in muscle mass. Endogenous creatinine clearance increased from 60 ml/minute ±7.7 (mean ± SEM) prior to operation to 77 ± 11.1 after operation (P < 0.05). Plasma aldosterone fell in the four patients studied from 82 ng/100 ml ± 21.7 (mean ± SEM) before operation to 16 ± 4.1 after operation (P < 0.025). Spontaneous 24-hour urine sodium excretion improved in only two off five patients, but sodium excretion in response to diuretics increased from 29 mEq/day ± 11.8 (mean ± SEM) before operation to 112 ± 22.1 after operation (P < 0.01). Untoward postoperative complications were consumptive coagulopathy with associated gastrointestinal bleeding, two patients; central venous congestion, three patients; fever, three patients. We conclude that the shunting procedure is effective in relieving resistant ascites and that it is associated with an increased glomerular filtration rate, decreased secondary hyperaldosteronism, and possible increased effective plasma volume. The autoinfusion of ascites with this shunt frequently is complicated by consumptive coagulopathy, central venous congestion, and fever.
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- The kidney in cirrhosis. I. Clinical and biochemical features of azotemia in hepatic failure.Ann Intern Med. 1964; 60: 353
- The kidney in cirrhosis. II. Disorders of renal function.Ann Intern Med. 1964; 60: 366
- Problems in abdominal surgery. I. Peritoneo-venous shunting for intractable ascites.J Miss State Med Assoc. 1976; 17: 5
- A seven year experience with side-to-side portocaval shunt for cirrhotic ascites.Ann Surg. 1968; 168: 655
- Hospital malnutrition and how to assess the nutritional status of a patient.Nutr Today. March/April, 1976; 18
- Evaluation of the peritoneal-button operation for ascites.N Engl J Med. 1950; 243: 857
- Intravenous therapy of massive ascites in patients with cirrhosis. II. Long term effects on survival and frequency of renal failure.Gastroenterology. 1967; 53: 220
- A rational approach to the hepatorenal syndrome.Gastroenterology. 1973; 65: 321
- Surgical treatment of ascites.N Engl J Med. 1946; 235: 581
- A case of ascites due to cirrhosis of the liver cured by operation.Br Med J. 1896; 2: 728
- Hepatopexy for chronic cirrhotic ascites.Surgery. 1966; 60: 1129
- An experience with a LeVeen ascites shunt.Arch Surg. 1976; 111: 302
- Drainage peritoneo-veineux de l'ascite cirrhotique.Nouv Presse. 1976; 5: 95
- Peritoneal atrial shunt for intractable ascites.Arch Surg. 1967; 95: 369
- Treatment of intractable ascites by peritoneal atrial shunt.JAMA. 1967; 201: 264
- Peritoneo venous shunting for ascites.Ann Surg. 1974; 180: 580
- Effects of changing plasma volume, serum albumin concentration, and plasma osmolality on renal function in cirrhosis.Gastroenterology. 1967; 53: 229
- The double portocaval shunt in the treatment of cirrhotic ascites.Surg Gynecol Obstet. 1960; 110: 457
- Intractable ascites.Minn Med. 1976; 59: 79
- Surgical treatment for intractable ascites.Am J Surg. 1968; 116: 929
- The absorption of ascitic fluid by means of ileo-entectropy in patients with advanced cirrhosis.Ann Surg. 1957; 146: 700
- Intractable ascites, surgical management with reduction in secondary hyperaldosteronism.JAMA. 1976; 236: 483
- Peritoneo-caval shunt with a Holter valve in the treatment of ascites.Lancet. 1962; 1: 671
- Intravenous therapy of massive ascites in patients with cirrhosis. I. Short term comparison with diuretic treatment.Gastroenterology. 1967; 53: 211
- Critical assessment of the rationale of thoracic duct drainage in the treatment of portal hypertension.Surgery. 1968; 63: 7
- The treatment of ascites by side to side portocaval shunt.Ann Surg. 1959; 150: 428
Accepted: April 12, 1977
☆This investigation was supported by U.S. Public Health Service grants AM 15736 and RR00039.
© 1978 Published by Elsevier Inc.