Treatment of refractory ascites in patients with liver disease.

In conclusion, an understanding of the pathophysiology of ascitic fluid formation and clearance in patients with liver disease has resulted in the development of new approaches to the treatment of refractory ascites. Although these techniques have been very successful in controlling ascites they have been associated with a number of complications which can contribute to both short and long term morbidity and mortality. An approach to the individual patient must be based on detailed evaluation of the associated liver disease, its potential reversibility, and documentation that the ascites is truly refractory. If ascites reaccumulates rapidly following ultrafiltration and reinfusion of ascitic fluid then careful consideration may be given to insertion of a peritoneovenous shunt. Careful pre- and postoperative monitoring is necessary if significant complications are to be avoided.