Correction of ascites with peritoneovenous shunting: a study of clinical management.

Although a medical regimen, with salt and water restriction and a progressive program of diuretics, ordinarily achieves relief of ascites in advanced liver disease, there has been rapid proliferation in the use of peritoneovenous shunting for persons who appear resistant to normal conservative therapy. Circumstances that justify this surgical approach have not been firmly established. Indications of a satisfactory result in the immediate postoperative period are hemodilution, increase in urine volume, decrease in body weight, and decrease in abdominal girth. Normalization of sodium excretion and serum BUN and creatinine levels are noted in patients with hepatorenal syndrome. Most commonly encountered complications are shunt malfunction, a coagulopathy that leads to generalized bleeding or to thrombosis of the shunt, ascitic fluid leak, and infection. Clarification of the risks and benefits of the procedure is yet to be determined through carefully designed clinical trials.