Saphenoperitoneal shunt for intractable ascites

OBJECTIVE: Ascites usually complicates chronic liver disease, and some patients with ascites are refractory to medical treatment. Recently, saphenoperitoneal shunt (SPS) was described to treat this condition. This procedure avoids the insertion of a foreign expensive shunt into the circulation. We present our experience with this procedure with some modification in the technique.

METHODS: We performed a prospective study on 11 patients with intractable ascites admitted to the Vascular Unit, Suez Canal University Hospital, Egypt from June 2001 to October 2003. We divided the long saphenous vein approximately at 15 cm distally. We turned the proximal cut end upwards and tunneled under the skin towards the midline in the suprapubic region where we anastomosed it to the peritoneum.

RESULTS: One patient died from liver failure 8 days after the operation. Two patients died during follow-up, one at 3 months from liver failure, and the other at 4 months from variceal hemorrhage. We lost one patient to follow up. Seven patients remained alive with patent shunt up to 6 months follow up.

CONCLUSION: The SPS is a safe and effective procedure in the management of intractable ascites.