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Lessons Learned From an Eight-Year Experience With 70 Patients

J. Timothy Fulenwider, MD; Robert B. Smith, III, MD; Stephen C. Redd, MD; Joseph D. Ansley, MD; J. Michael Henderson, MB, ChB, FRCS; William F. Millikan, MD; John T. Galambos, MD; W. Dean Warren, MD

Arch Surg. 1984;119(10):1133-1137.

Abstract
• The peritoneovenous shunt (PVS) is preferred over other treatment modalities in the treatment of the cirrhotic patient who has intractable ascites. The favorable effects on nutrition, pulmonary, and renal function, in addition to prompt control of ascites, frequently overshadow potentially life-threatening complications. We summarized our experience with the PVS in 70 patients with portal hypertension at Emory University, Atlanta, and identified the perioperative complications and operative mortalities. Late complications of sepsis and variceal hemorrhage were frequent and often were fatal. Of the multiple preoperative clinical and laboratory determinants, only the serum bilirubin level (3 mg/dL) was predictive of the operative mortality and longevity of survivors. The PVS should be reserved for patients with disabling, truly refractory ascites.

(Arch Surg 1984;119:1133-1137)

Author Affiliations
From the Joseph B. Whitehead Department of Surgery (Drs Fulenwider, Smith, Ansley, Henderson, Millikan, and Warren), and the Departments of Medicine (Dr Redd) and Internal Medicine (Dr Galambos), Emory University School of Medicine, Atlanta. Dr Redd is now with The Johns Hopkins School of Medicine, Baltimore.

Footnotes
Accepted for publication June 12, 1984.

Presented at the Seventh Annual Meeting of the Association of Veterans Administration Surgeons, Airlie, Va, May 27, 1983.

Reprint requests to Emory Clinic, 1365 Clifton Rd, Atlanta, GA 30322 (Dr Fulenwider).

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