Current status of the peritoneovenous shunt for the management of intractable ascites

Renewed interest in the management of intractable ascites has led to the use of a peritoneovenous shunt for its control. Analysis of Canadian experience with this technique in the last 2 years has demonstrated that there are problems associated with it that have not been reported in the surgical literature. A group of 60 patients who underwent peritoneovenous shunting at several Canadian centres was analysed. The operative mortality was 20% but was related to the underlying disease rather than to the operative procedure. Although the initial response to shunting was excellent in 53%, long-term patency (more than 3 months) was achieved in only 43%, but the procedure greatly improved the quality of life in those patients. The indications for shunting, the complications, results and cumulative patency rates are discussed.