Our experience with saphenoperitoneal shunt for patients with refractory ascites

Background: In 1992, Pang and colleagues described their ingenious method for the management of patients with refractory ascites: a 15cm proximal segment of the long saphenous vein (VSM) curved up to the abdominal wall through a subcutaneous tunnel is directly anastomosed to the peritoneum. This technique employs the inflow valves of VSM as a biological valve system for creating a unidirectional route for ascites flow. This procedure reduces significantly the need for diuretics and the number of the repeated paracentesis. Employing autologous vein is a cost saving method that eliminates the complications of the former plastic shunts as well as occlusion of the collector branches and valves and septic complications.

Method: In our department the above surgical technique has been applied since 2001 and we performed about 29 operations. All patients had alcoholic cirrhosis of Child's grade B or C. Breakdown by sex: 24 men, 5 women. Mean age: 49 years (range: 33 to 71 years). Mortality: 5 patient deceased. 3 patients died of hepatargic coma, 1 of esophageal variceal rupture, 1 of peritonitis after duodenal ulcer perforation. No patient was lost during surgical interventions and in the early postoperative stage, respectively. In our material no DIC occurred. As a late complication, an abdominal hernia was observed in 3 cases. The complications occurred directly after operation are as follows: wound healing disturbances, ascites leakage, hemorrhage, lymph leakage. Conclusions: Evaluating the operations performed by our team, the SP shunt seems to be suitable for the management of refractory ascites. In case that the VSM shows varicosity, a valve insufficiency is present or the deep vein outflow is hindered, and the SP shunt gets occluded later on, respectively, the implantation of LeVeen shunt is performed. In our practice we had to implant synthetic shunts in 4 instances. In 1 case we found early occlusion of the shunt, related to a septic complication. In the other 3 cases the follow-up confirmed a late reocclusion. If the SP shunt is occluded for a certain reason, this makes the implantation of the formerly applied synthetic shunt not impossible.