Peritoneovenous shunting for intractable ascites.

For 5 years (1976-1981) peritoneovenous shunting has been used in 32 patients with intractable ascites--that is, in patients in whom medical therapy has failed. All operations but one were performed using local anesthesia. The LeVeen shunt was used in 29 patients and the Denver shunt in three patients. Good palliation was achieved in 14 of 23 patients with ascites due to liver cirrhosis. Seven out of eight patients with tense ascites secondary to malignancy were relieved. Complications were seen in six patients. In one patient severe disseminated intravascular coagulopathy made removal of the shunt necessary. Leakage, local infection, and skin necrosis, when present, could successfully be treated without removing the shunt. The surgical procedure is simple and offers relief to most patients with tense ascites resistant to medical therapy.