Early implantation of Denver shunt.

BACKGROUND/AIMS: The Denver peritoneovenous shunt is useful in the resolution of refractory ascites, because it alleviates symptoms and allows effective palliation. However, this shunt did not prolong the life expectancy of patients with decompensated liver cirrhosis. Therefore, when deciding whether or not to implant a Denver shunt, it is important to determine the condition of the patient with refractory ascites. Here, we determined the appropriate time for Denver shunt implantation. METHODOLOGY: We retrospectively studied 21 patients who underwent Denver shunt implantation for hepatic failure-related ascites. The patients were divided into PC and WPC groups depending on whether or not paracentesis was performed before implantation of the Denver shunt, respectively. RESULTS: The mean interval from hospital admission to Denver shunt implantation was significantly shorter in the WPC group (9.0±2.2 days) than in the PC group (25.9±5.9 days) (p<0.0001). The mean survival time was significantly longer in the WPC group (8.4±2.5 months) (p<0.0071) than in the PC group (5.6±1.7 months). CONCLUSIONS: Early implantation of a Denver shunt should be considered for the treatment of ascites that is resistant to conservative medical therapy.

Implantation of a Denver shunt by left subclavian approach for preventing kinking.

Ascites often contributes to patient morbidity and discomfort. Implantation of a Denver peritoneovenous shunt is one of the treatments for refractory ascites. However, the dysfunction of the shunt is frequently observed and requires further improvement. Here, the present paper reported the improved implantation technique for the Denver peritoneovenous shunt. All the procedures were performed in the operating suite under general anesthesia. In all patients, the shunts were percutaneously placed via the left subclavian vein approach under digital fluoroscopic guide along with ultrasound. Fourteen shunts were implanted in 14 patients with hepatic failure-related ascites. The shunt was successfully positioned in all patients in an average time of 45 min without the kinking. No complications directly related to the procedure occurred. The Denver peritoneovenous shunt is useful in resolution of refractory ascites, as it reduces symptoms, and allows effective palliation. Implantation of the Denver peritoneovenous shunt via left subclavian vein approach is a relatively easy, rapid, and secure procedure that prevents kinking.