Treatment of ascites in patients with liver cirrhosis

Zatevahin I.I.¹, Ciciashvili M.Sh.¹, SHipovskij V.N.¹, Monahov D.V.^{1, 2}, Chelyapin A.S.^{1, 2}, Azimov S.A.^{1, 2}

Aim. Evaluate the optimal treatment of refractory ascites in patients with liver cirrhosis.

Materials and methods. Article describes the treatment experience of 170 patients with liver cirrhosis complicated by refractory ascites. All patients had grade III ascites (according to the international Ascites Club classification). Due to the method of treatment, patients subdivided into 2 groups: group 1 — transugular intrahepatic portosystemic bypass grafting (N = 93), patients of group 2 — laparocentesis in combination with conservative therapy (N = 77). Portal hypertension (caused by liver cirrhosis) was revealed in the both groups of patient. Results of treatment were investigated after 3 and 6 months.

Results. In the first group — were revealed 5 patients with refractory ascites after 3 months of treatment, 3 patients with refractory ascites after 6 months (in all of the cases refractory ascites was caused by thrombosis of the shunt). Mortality in the group 1 was 6.5% (N = 6), because of progression of hepatic-cellular failure. In the second group — were revealed 14 patients with progression of ascites in 3 months after operation, from 3–6 months in 5 patients. Mortality in the group 2 was 26% (N = 20).

Conclusion. According to the results of our study, as well as according to the literature, the most optimal way of surgical treatment of refractory ascites in patients with liver cirrhosis is transjugular intrahepatic portosystemic bypass surgery.

1. Garbuzenko D. V. The principles of management of patients with liver cirrhosis complicated by ascites. Klin Med (Mosk). 2017;95(9):789–796. doi: 10.18821/0023-2149-2017-95-9-789-796.

2. Ivashkin VT, Mayevskaya MV, Pavlov ChS, et al. Treatment of liver cirrhosis complications: Clinical guidelines of the Russian Scientific Liver Society and Russian gastroenterological association. Russian journal of gastroenterology, hepatology, coloproctology. 2016;26(4):71–102. (In Russ.).

3. Roitberg GE, Strutynskii AV. Internal disease. Liver, biliary tract, pancreas. Moscow: Medpress-inform; 2013. 632 p.

4. Haberl J, Zollner G, Fickert P, Stadlbauer V. To salt or not to salt? – That is the question in cirrhosis. Liver Int. 2018;38(7):1148–1159. doi: 10.1111/liv.13750.

5. Lenz K, Buder R, Kapun L, Voglmayr M. Treatment and management of ascites and hepatorenal syndrome: an update. Therap Adv Gastroenterol. 2015;8(2):83–100. doi: 10.1177/1756283X14564673.

6. Reiberger T, Püspök A, Schoder M,et al. Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III). Wien Klin Wochenschr. 2017;129(Suppl 3):135–158. doi: 10.1007/s00508-017-1262-3.

7. Solà E, Solé C, Ginès P. Management of uninfected and infected ascites in cirrhosis. Liver Int. 2016;36 Suppl 1:109–115. doi: 10.1111/liv.13015.