30 consecutive patients with cirrhosis of the liver complicated by refractory ascites, hepatorenal syndrome, or both, received a LeVeen peritonealvenous shunt. After surgery, these patients demonstrated a decreased abdominal girth (108 vs 93 cm, P <.001), decreased body weight (80 vs 70 kg, P <.001), and increased urinary flow (607 vs 4,254 ml, P <.001). All patients had previously failed to show substantial benefit with 7 to 124 days of medical care. The mean BUN value was significantly decreased, from 39 to 23 mg/100 ml (P <.005). Aldosterone retention was reduced from a mean value of 32 to 12.8 ng/100 ml. The LeVeen continuous peritoneal-venous shunt is an important innovation that completely relieves refractory ascites in cirrhotic patients and reverses the pathophysiology of the hepatorenal syndrome.
(JAMA 237:131-133, 1977)