Abstract
Introduction
Ascites is a common complication of liver cirrhosis and represents the main cause of hospitalization among patients with cirrhosis. First-line therapy for those patients is the use of diuretics and dietary sodium restriction. However, 10 % of patients per year become therapy refractory to diuretic treatment with the need of repeated high-volume paracentesis or transjugular intrahepatic portosystemic shunt (TIPS). For these patients, an automated pump system (Alfapump/Sequana Medical) was developed. Here, we describe our single-center experience of ten consecutively implanted pump systems.
Patients and methods
Between 08/13 and 11/14, ten Alfapump systems were implanted in patients with refractory ascites all suffering from liver cirrhosis. Those patients were treated as a bridge to transplant (4/10) or as an end-stage therapy (6/10). Median follow-up was 165 days (23–379 days).
Results
Postimplant, the need of paracentesis could be markedly reduced to a mean of 0.45 (0–4/month) per month. In eight patients, paracentesis was not needed after implantation of the pump system. The median daily output volume was 1000 ml/day (450–2000 ml/day). Prerenal insufficiency was a recurrent complication in the postoperative period.
Discussion
The Alfapump system is a useful system in the treatment of patients suffering from therapy refractory ascites. However, due to the high level of comorbidities, careful patient selection and postoperative monitoring are required.
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Thomas, M.N., Sauter, G.H., Gerbes, A.L. et al. Automated low flow pump system for the treatment of refractory ascites: a single-center experience. Langenbecks Arch Surg 400, 979–983 (2015). https://doi.org/10.1007/s00423-015-1356-1
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DOI: https://doi.org/10.1007/s00423-015-1356-1