Indigenous cost-effective peritoneo-venous shunt for refractory ascites.

About 5% of patients with chronic liver disease develop massive refractory ascites. These patients cease to respond to diuretic therapy and may develop prerenal azotemia. There is a small but definite role for the peritoneo-venous shunt in these patients. In our study of 36 patients, managed with locally made, single-valved peritoneo-venous shunts (GSAIMS shunts), shunt failure and complication rates were assessed postoperatively. There is a definite improvement in quality of life with this cost-effective locally made shunt if patients are selected carefully. Long-term follow-up of these patients is not possible because most of these patients succumb to advanced liver disease.

Evaluation of peritoneovenous shunt in refractory cirrhotic ascites in Indian patients.

Ten patients with tense and refractory cirrhotic ascites underwent a modified peritoneovenous shunt procedure. Nine patients responded with complete resolution of ascites, mean weight gain of 5 (range 0-8) Kg, and rise in serum albumin level of 0.6 g/dL. Six patients improved from Child's class B to A. The longest survival period was 2.3 years. The main constraint in a developing country is the high cost of the shunt.

[Cost of the peritoneovenous shunt in patients with cirrhosis]. / Coût de la dérivation péritonéo-veineuse chez le cirrhotique.

The cost of peritoneovenous shunting was evaluated in 15 cirrhotic patients with intractable ascites. With the assessment presently used in French Public Hospitals which is based on a contractual reimbursement by the Social Security per day of hospitalization, the cost of peritoneovenous shunting was F 37,227.40. Using the more refined method of cost analysis, the cost of the operative procedure was F 9,564 and that of postoperative hospitalization was F 8,067. Total expenses calculated by the cost analysis method (F 17,631) were much less that the reimbursement paid by Social Security. This study allowed to determine the actual cost of Surgical treatment of ascites, where expenses were greatest, and how to reduce them. Results of this report should be used when comparing cost and efficacy of medical and surgical treatments.