Percutaneous implant of Denver peritoneo-venous shunt for treatment of refractory ascites: a single center retrospective study

M. Piccirillo, L. Rinaldi, M. Leongito, A. Amore, A. Crispo, V. Granata, P. Aprea, F. Izzo

Department of Abdominal Surgical Oncology and Hepatobiliary Unit, “Istituto Nazionale Tumori IRCCS Fondazione Pascale – IRCCS di Napoli”, Naples, Italy. lucarinaldi@hotmail.it

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• Gastroenterology

OBJECTIVE: Refractory ascites is defined as a lack of response to high doses of diuretics or the development of diuretic related side effects, which compel the patient to discontinue the diuretic treatment. Current therapeutic strategies include repeated large-volume paracentesis and transjugular intrahepatic portosystemic shunts (TIPS). Peritoneovenous shunt (Denver shunt) should be considered for patients with refractory ascites who are not candidates for paracentesis or TIPS. This study presents our case series in the implant of Denver peritoneovenous shunt.

PATIENTS AND METHODS: Sixty-two patients underwent percutaneous placement of Denver shunt between November 2003 and July 2014. There were 36 men and 26 women. Ascites was secondary to alcoholic cirrhosis in six patients, cryptogenic cirrhosis in six, and virus-related cirrhosis in fifty of them. Liver cirrhosis was classified as Child B in 22 patients and Child C in 40 (no patient was Child A).

RESULTS: All implants were successfully performed. There were no intraoperative problems or lethal complications; our patients were hospitalized for 2 or 3 days. Postoperative complications included: infection of the shunt in 3 patients (4.8%), shunt obstruction in 4 (6.4%) and transient abdominal pain in 4 (6.4%). Significant symptomatic relief was obtained in all patients.

CONCLUSIONS: The percutaneous placement of a Denver shunt is a technically feasible and effective method for symptomatic relief of refractory ascites.

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