Browsing by Author "Jayakody, M."

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Sapheno-peritoneal shunting for treatment of resistant ascites
(Sri Lanka Medical Association, 1998) Deen, K.I.; Jayakody, M.; de Silva, A.P.; Bodhipakse, S.; de Silva, H.J.
INTRODUCTION: Prosthetic peritoneovenous shunts are useful to manage resistant ascites due to portal hypertension. However, they are expensive and not widely available. AIM : To assess the efficacy to direct sapheno-peritoneal shunting (SPS) in the treatment of resistant ascites due to portal hypertension. SETTING : University Medical and Surgical Units, Colombo North General Hospital. METHODS : Six male alcoholic cirrhotics (age range 39-68 years) with ascites resistant to diuretics and paracentesis were offered this procedure. Two had evidence of early encephalopathy. SPS was performed under general anaesthesia in 5 and spinal anaesthesia in one. Procedure consisted of division of the saphenous vein 5-6 cms distal to the saphenofemoral junction and connecting the proximal cut end to the peritoneal reflexion above the inguinal ligament. RESULTS : There was no surgical mortality. Control of ascites was considered satisfactory in 5 of the 6 patients (reduction in discomfort, abdominal girth, diuretic requirement and no further paracentesis necessary). The Childs grade improved in 3 of the 6 patients and remained unchanged in 3. One patient required repeated paracentesis, developed severe hepatic encephalopathy and died three months after surgery. Wound infection was seen in 3 patients and a temporary peritoneal fluid leak was seen in another 3. At the time of discharge from hospital Doppler ultrasound showed that the shunt was patent and EEC showed no evidence of encephalopathy in any-patient. CONCLUSION : Although our numbers are small, in the short-term, SPS appears to be useful and relatively safe for control of resistant ascites. It is appropriate for poor countries as an alternative to prosthetic shunts.
Saphenoperitoneal anastomosis for resistant ascites in patients with cirrhosis
(Elsevier, 2001) Deen, K.I.; de Silva, A.P.; Jayakody, M.; de Silva, H.J.
BACKGROUND: Restriction of salt intake and diuretics combined with repeated paracentesis has been the mainstay of managing longstanding ascites. Peritoneal-venous shunts have been employed in refractory ascites but are not without complication. We evaluated an autologous reversed segment of proximal long saphenous vein anastomosed to the peritoneum in management of patients with resistant ascites. METHODS: Eleven patients (8 male, median age 48 years, range 37 to 68) with tense refractory ascites associated with cirrhosis of the liver and portal hypertension underwent saphenous vein-peritoneal anastomosis by rotating the proximal vein cephalad which was anastomosed to peritoneum in the posterior wall of the inguinal canal. Ten of 11 procedures were performed under general anesthetic. RESULTS: Thirty-day mortality was 1 patient. Morbidity included transient hepatic encephalopathy in 4 (36%), minor wound hemorrhage in 3 (27%), fluid leakage in 7 (64%), and wound infection in 7 (64%). Hospital stay (median) was 16 days (range 11 to 23). In the short term (median of 9 months) significant reduction in body weight and abdominal girth was seen in 9 (90%), 6 (60%) were not on diuretics while 3 (30%) continued to remain on reduced doses of diuretic. Furthermore, 7 (70%) did not require paracentesis. At 2-year follow-up, 5 (45%) patients had died and 3 were lost to follow-up. The remaining 3 were all in active employment, 1 was off diuretics, and 2 were on reduced doses. All 3 patients maintained reduced body weights and abdominal girths compared with preoperative values. CONCLUSIONS: Saphenous-peritoneal anastomosis appears a simple, safe, and effective method of achieving long-term control of refractory ascites. The use of a biological shunt is an added advantage over prosthetic shunts for drainage of ascitic fluid