Patient Selection and Survival after Peritoneovenous Shunting for Nonmalignant Ascites

Smith, Robert E.; Nostrant, Timothy T.; Eckhauser, Frederic E.; Wilson, Joanne P.; Knol, James A.; Strodel, William E.
August 1984
American Journal of Gastroenterology;Aug1984, Vol. 79 Issue 8, p659
Academic Journal
Patient selection and survival after peritoneovenous shunting for nonmalignant ascites was assessed in 30 patients undergoing 44 peritoneovenous shunting procedures over a 5-year period. Indications for peritoneovenous shunting included refractory ascites alone, refractory ascites complicated by hepatorenal syndrome, and nonrefractory but recurrent ascites. Fifty-six percent of shunting procedures were complicated by shunt malfunction and an additional 13% ended in shunt removal or ligation. Serious perioperative morbidity occurred in 47% of patients. Mean duration of shunt function was significantly less (p < 0.05) in the patients with hepatorenal syndrome (15 ± 5 days) compared to the patients with refractory ascites alone (45 ± 13 days), or the patients with nonrefractory ascites (64 ± 34 days). Mean survival was 265 ± 87 days. Survival of patients with nonrefractory ascites (767 ± 214 days) was significantly longer (p < 0.05) than that seen in patients with hepatorenal syndrome (28 ± 5 days) or in patients with refractory ascites alone (256 ± 148 days). Combined inhospital mortality was 30%. It was significantly greater (p < 0.05) in patients with hepatorenal syndrome (70%) than in patients with refractory ascites alone (14%) or in patients with nonrefractory ascites (0%). We conclude that patient selection significantly influences survival after peritoneovenous shunting and may account for the varying results reported by other groups.


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