Role of Peritoneal Ports for Treatment of Intractable Ascites

Abstract

Introduction: Ascites is a common complication of advanced malignancies and cirrhosis. Symptoms of marked abdominal distention, shortness of breath, diminished appetite, fatigue, and lower-extremity edema can significantly compromise a patient’s everyday life. Treatment options for intractable ascites include serial paracentesis, peritoneovenous shunting, transjugular intrahepatic portosystemic shunt (TIPS) creation, and tunneled peritoneal catheters that may be external or, more recently, attached to subcutaneous ports. It is therefore appropriate to evaluate a port specifically designed for peritoneal access as a mean of controlling intractable ascites. We present a minimally invasive treatment for palliative drainage of symptomatic ascites in patients with advanced malignancy. Aim of the work: The aim of this work is to evaluate the percutaneous implantable access system specifically designed for peritoneal access as a method to control intractable ascites as regards complications and patency. Methods: This is a prospective intervention study will be conducted on 40 patients with intractable ascites referred from the oncology clinic to the diagnostic imaging department for percutaneous placement of peritoneal portcath as a palliative treatment for the patient. Results: Good technical success rate (100%) in insertion was found with removal of ascites gradually. Immediate relief of symptoms (100%). There were no major complications. There was one minor complication(2.5%), a leakage at the port placement site in a patient with pancreatic carcinoma. The leakage stopped spontaneous with removal of ascites and the patient underwent conservative management. Conclusion: peritoneal port systems for treatment intractable ascites is efficient way to avoid ascites related morbidity with increases patient compliance, satisfaction by decreased hospital visits as the drainage and patients monitor can be done in their homes. Port aspiration can be performed in some cases by patients or family members without nursing assistance. In comparison with tunneled peritoneal catheters with external components, the complication rate appears to be minimal.