Insertion of Peritoneal-Venous Shunt

Name of the Procedure:

• Common Names: Peritoneal-venous shunt, Denver shunt
• Technical Terms: Peritoneovenous shunt insertion, LeVeen shunt

Summary

Insertion of a peritoneal-venous shunt is a surgical procedure where a tube (shunt) is placed to connect the peritoneal cavity (abdomen) to the venous system (veins). This allows the fluid to be redirected and absorbed back into the bloodstream.

Purpose

• Medical Condition: Refractory ascites (accumulation of fluid in the abdominal cavity that does not respond to medical treatment).
• Goals: To alleviate symptoms associated with excessive abdominal fluid, prevent repeated fluid build-up, and improve the patient's quality of life.

Indications

• Persistent or recurrent ascites unresponsive to medical management.
• Symptoms like abdominal discomfort, difficulty breathing, or impaired mobility due to fluid accumulation.
• Patients with conditions such as cirrhosis of the liver or certain cancers leading to chronic ascites.

Preparation

• Pre-procedure fasting for at least 8 hours.
• Medication adjustments as directed by the physician, possibly including blood thinners.
• Diagnostic tests: Blood tests, imaging studies like ultrasound or CT scan to assess the peritoneal cavity.
• Consent: Understanding the risks and benefits and giving informed consent.

Procedure Description

1. Anesthesia: The patient is given general or local anesthesia for comfort.
2. Incision: Small incisions are made in the abdomen and neck.
3. Insertion: The shunt is carefully inserted with one end in the peritoneal cavity and the other in the jugular or subclavian vein.
4. Securing: The shunt is secured in place, and the incisions are closed.
5. Confirmation: The placement of the shunt is confirmed using imaging techniques.

Duration

• Typically takes 1 to 2 hours.

Setting

• Performed in a hospital operating room or surgical center.

Personnel

• Surgical team including a surgeon, nurses, and an anesthesiologist.

Risks and Complications

• Common: Infection, bleeding, shunt malfunction or blockage.
• Rare: Blood clots, damage to surrounding structures, severe allergic reactions to anesthesia.
• Management: Immediate medical intervention if complications arise, regular monitoring post-operation.

Benefits

• Reduction in abdominal fluid and alleviation of associated symptoms.
• Improved mobility and comfort.
• Benefits can often be seen shortly after the procedure.

Recovery

• Post-procedure hospital stay for monitoring, typically 1-2 days.
• Instructions: Rest, avoid strenuous activities for a few weeks, wound care.
• Follow-up appointments for shunt function assessment and ongoing monitoring.

Alternatives

• Paracentesis: Regular removal of fluid through needle aspiration.
  • Pros: Less invasive, can be performed frequently.
  • Cons: Temporary relief, requires repeated procedures.
• Medication Management: Diuretics to reduce fluid accumulation.
  • Pros: Non-invasive.
  • Cons: Limited effectiveness in refractory cases, potential side effects.

Patient Experience

• During: Under anesthesia, so minimal awareness of the procedure.
• After: Possible soreness at the incision sites, managed with pain medication.
• Recovery: Gradual return to normal activities, focus on hydration and nutrition, regular follow-ups to monitor shunt performance.