Should Portosystemic Shunt Be Reconsidered in the Treatment of Intractable Ascites in Cirrhosis?

Dominique Franco, MD; Corinne Vons, MD; Oscar Traynor, MCh, FRCSI; Claude de Smadja, MD
Arch Surg. 1988;123(8):987-991. doi:10.1001/archsurg.1988.01400320073015.
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• Fifty-seven cirrhotic patients with intractable ascites had a portosystemic shunt. In 35 patients, a peritoneovenous shunt had previously failed. Forty-six patients were in Pugh's class B and 11 were in class C. There were three operative deaths (5.3%). Fifty-three (98.2%) of the 54 survivors were cleared of ascites. In one patient, ascites persisted because of postshunt heart failure that resulted in a marked increase of caval pressure. Twenty-seven patients (50%) had late encephalopathy, which was severe and disabling in 12 (22%). One- and three-year survival rates were 72% and 36%, respectively. These results suggest that although portosystemic shunts are remarkably effective in dealing with ascites, the high rate of postoperative encephalopathy is a strong argument against their routine use in the management of intractable ascites in cirrhosis.

(Arch Surg 1988;123:987-991)


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