Thoracic duct-subclavian vein anastomosis in management of cirrhotic ascites.

Reanastomosis of the thoracic duct and subclavian vein has been performed in three patients with intractable ascites. Following surgery, these patients were placed on a loop-blocking diuretic plus Aldactone, and prompt diuresis ensued with gradual improvement in the ascites. Improvement in the ascites was probably the result of several factors including removal of obstruction at the upper end of the thoracic duct, mobilization of fluid in the intravascular space, improved lymphatic drainage, and diuretic effect. Complications included necessity for re-exploration in one patient and development of encephalopathy in a second patient.