TREATMENT OF INTRACTABLE ASCITES IN PATIENTS WITH ALCOHOLIC CIRRHOSIS BY PERITONEOVENOUS SHUNTING (LEVEEN)

Several hemodynamic abnormalities in the patient with cirrhosis comprise a unique distributive circulatory disturbance that causes intractable ascites and that is, in turn, worsened by the resulting ascites. Ascites is promptly alleviated by drainage of the ascitic fluid into the intravacular compartment. The circulatory abnormalities improve in part because of elimination of the ascites, and also because of a compensatory hypervolemia. The consequences of the latter, especially in the immediate postoperative period, are increased likelihood of pulmonary edema and of gastrointestinal bleeding from heightened portal vein pressure. Postoperative coagulopathy is also a significant problem. Careful selection of patients for the procedure, close postoperative observation and vigorous use of diuretics and other agents will usually enable these complications to be obviated or successfully treated. Increases in body muscle and fat masses and serum albumin concentrations indicate nutritional improvement. Despite evidence of benefits from the procedure, these patients continue to die from the complications that threaten other cirrhotics: effects of return to alcoholism, gastrointestinal hemorrhage, recurrent infections and intestinal obstruction. Thus, it is not yet clear that the benefits include prolongation of life.