Abstract
A total oftwenty six peritoneovenous shuntings were performed in our department between 1978 and 1984, on twelve cirrhotic and ten cancerous patients with intractable ascites, using Pudenz, LeVeen or Denver type shunting tubes. Reduced ascites was noted postoperatively with statistical significance in both the cirrhotic group (p<0.05) and the cancerous group (p<0.01), of whom eight cirrhotic and seven cancerous patients exhibited an abdominal girth reduced by 9.7cm (a 10.9 per cent reduction) in two weeks. A larger urinary output was noted in 13 patients, with a mean increase of 587 ml/day compared with the pre-shunting output. These patients lost a mean weight of 6.13 kg in two weeks, while the non-reduced ascites group gained weight. The post-shunting serum albumin level was higher in the reduced ascites group. The mean functioning periods of the shunts were 5.1 and 2 months, respectively for the cirrhotic and cancerous patients whose shunts were patent. The patients’ outcome was shown to depend on the disease itself, with the exception of one patient who died of disseminated intravascular coagulopathy following shunting. In comparing several types of shunting systems, the Denver-type was proven as being the most unlikely to plug or malfunction because of its simpler structure.
Similar content being viewed by others
References
Kaiser GC, Lempke RE, King RD, King H. Intravenous-infusion of ascitic fluid. Arch Surg 1962; 85: 763–711.
Davis HA, Blalock JF Jr. Autologous and homologous transfusion of human ascitic fluid. J Clin Invest 1939; 18: 219–224.
Greene CH. Physiologic considerations in the treatment of portal cirrhosis. JAMA 1943; 121: 715–720.
Smith AN. Peritoneocaval shunt with a Holter valve in the treatment of ascites. Lancet 1962; 1: 671–672.
LeVeen HH, Christoudias G, Ip M, Luft R, Falk G, Grosberg S. Peritoneo-venous shunting for ascites. Ann Surg 1974; 180: 580–591.
Agishi T, Suzuki T, Yamashita Y, Takahashi K, Ota K. Treatment of intractable ascites with peritoneovenous shunt pump. Nippon Rinsho Geka Gakkai Shi (J Jpn Soc Clin Surg) 1979; 40: 1019. (in Japanese)
Hinoue S, Sawada T, Ikenaga T, Akiyama H, Yoshiba A, Kumada H, Takeuchi K, Oyake E, Nishikage S, Wada K. Peritoneo-venous shunt for intractable ascites in the patients of far advanced carcinoma. Rinsho Geka (J Clin Surg) 1980; 35: 1469–1475. (in Japanese)
Akita H, Kawada T, Nakayama H. The treatment of intractable ascites accompanied by carcinoma of alimentary tract in advanced stage. Shokaki Geka (Gastroenterol Surg) 1981; 4: 159–166. (in Japanese)
Kurata S, Yasutake S, Nakahara Y, Kawano Y, Esato K, Mohri H, Fujii Y. Peritoneo-venous shunting for intractable ascites. Nippon Rinsho Geka Gakkai Shi (J Jpn Soc Clin Surg) 1982; 43: 294–298. (in Japanese)
Akimaru K, Shibuya T, Ohba H, Hioki M, Matsuyama Y, Oyama T, Takahashi N, Soga R, Shoji T. The experience with peritoneovenous shunt for intractable ascites. Nippon Rinsho Geka Gakkai Shi (J Jpn Soc Clin Surg) 1982; 43: 584–590. (in Japanese).
LeVeen HH, Wapnick S. Operative details of continuous peritoneo-venous shunt for ascites. Bull Soc Int Chir 1975; 6: 579–582.
Britton RC. A new technique for rapid control of cirrhotic ascites. Arch Surg 1961; 83: 364–369.
Wapnick S, Grosberg S, Kinney M, Azzara V, LeVee HH. Renal failure in ascites secondary to hepatic, renal, and pancreatic disease. Arch Surg 1978; 113: 581–585.
Berkowitz HD, Mullen JL, Miller LD, Rosato EF. Improved renal function and inhibition of renin and aldosterone secretion following peritoneovenous (LeVeen) shunt. Surgery 1978; 84: 120–126.
Blendis LM, Greig PD, Langer B, Baigrie RS, Ruse J, Taylor BR. The renal and hemodynamic effects of the peritoneovenous shunt for intractable hepatic ascites. Gastroenterology 1979; 77: 250–257.
Greenlee HB, Stanley MM, Reinhardt GF. Intractable ascites treated with peritoneovenous shunts (LeVeen). Arch Surg 1981; 116: 518–524.
Grischkan DM, Cooperman AM, Hermann RE, Carey WD, Fergson DR, Cook SA. Failure of LeVeen shunting in refractory ascites—A view from the other side. Surgery 1981; 89: 304–308.
Kirchmer N, Hart U. Radionuclide assessment of LeVeen shunt patency. Ann Surg 1977; 185: 145–146.
Oosterlee J. Peritoneovenous shunting for ascites in cancer patients. Br J Surg 1980; 67: 663–666.
Holman JM Jr, Albo D Jr. Peritoneovenous shunting in patients with malignant ascites. Am J Surg 1981; 142: 774–776.
Dupas JL, Remond A, Vermynck JP, Capron JP, Lorriaux A. Superior vena cava thrombosis as a complication of peritoneovenous shunt. Gastroenterology 1978; 75: 899–900.
Eckhauser FE, Strodel WE, Knol JA, Turcotte JG. Superior vena caval obstruction associated with long-term peritoneovenous shunting. Ann Surg 1979; 190: 758–760.
Lerner RG, Nelson JC, Corines P, Guercio M. Disseminated intravascular coagulation: Complication of LeVeen peritoneovenous shunts. JAMA 1978; 240: 2064–2066.
Schwartz ML, Swaim WR, Vogel SB. Coagulopathy following peritoneovenous shunting. Surgery 1979; 85: 671–676.
Ojiro M. Coagulant and procoagulant factors in ascitic fluid.—about etiology of DIC induced by ascitic fluid infusion.—Igaku Kenkyu (Acta Medica) 1981; 51: 177–185. (English Abstract)
LeVeen HH, Wapnick S, Grosberg S, Kinney MJ. Further experience with peritoneo-venous shunt for ascites. Ann Surg 1976; 184: 574–581
Eckhauser FE, Strodel WE, Girardy JW, Turcotte JG. Bizarre complications of peritoneovenous shunts. Ann Surg 1981; 193: 180–184.
Maat B, Oosterlee J, Spaas JAJ, White H, Lammes FB. Dissemination of tumor cells via LeVeen shunt. Lancet 1979; 1: 988.
Raaf JH, Stroehlein JR. Paliation of malignant ascites by the LeVeen peritoneo-venous shunt. Cancer 1980; 45: 1019–1024.
Berger A, Goldberg MI. Subcutaneous cancer growth complicating the peritoneovenous shunting of malignant ascites. Surgery 1983; 93: 374–376.
Straus AK, Rosenman DL, Shapiro TM. Peritoneovenous shunting in the management of malignant ascites. Arch Surg 1979; 114: 489–491.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Akimaru, K., Ueda, Y. & Shoji, T. Peritoneovenous shunting for intractable cirrhotic and cancerous ascites using different types of shunting tubes. The Japanese Journal of Surgery 18, 502–508 (1988). https://doi.org/10.1007/BF02471482
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02471482