Ascites, Medical Treatment or Peritoneovenous Shunt, A Prospective Comparative Preliminary Report

Abstract

The massive cirrhotic ascites was a common problem, most of them were treated by medical treatments that caused many complications and mortality. Peritoneovenous shunt (PV shunt) was another choice that caused less complication and less mortality. A prospective, comparative study was performed to determine the result of medical treatments for massive ascites compared with peritoneovenous shunt.

The 36 cirrhotlc ascites patients (21 males, 15 females) whose abdominal circumferences were more than 85 cm., non hepatitis, without any emergency indication for PV shunt and ready for study, were admitted in Makarak hospital from January 1991 to July 1995. The patients were stratified into two groups randomly, Group 1 (medical treatments, n = 18), Group 2 (surgical treatment by PV shunt, n = 18).

The two groups of patients were similar in regard to age, sex, diagnosis and other. The abdominal circumferences decreased to 95% after treatment in Group 1, compared with decreased to 80% in Group 2. The mortality rates in group 1 on the first admission (13/18 = 72%) were significantly higher than group 2 (2/18 = 11%). The causes of death in group 1 were hyponatremia with hepatorenal syndromes, hepatic encephalopathy and massive hydrothorax with respiratory failure. The causes of death in group 2 were aspirated pneumonitis and respiratory failure.

The result showed that PV shunt was better than medical treatments for massive ascites in these patients which were classified as hopeless cases.