Implantation of a skin graft tube to create a saphenoperitoneal shunt for refractory ascites

Purpose. We evaluated the effectiveness of placing a skin tube in the subcutaneous plane to manage refractory ascites by draining the ascitic fluid from the peritoneal cavity into the long saphenous vein. Methods. Twenty patients with refractory ascites underwent this technique which was performed in two stages. In the first stage, a thin piece of partial thickness skin graft was rolled into a tube and implanted in the subcutaneous plane of the lower abdomen and the upper thigh near and parallel to the upper segment of the long saphenous vein. In the second stage, which was done 3 months later, we anastomosed the upper end of the skin tube to the peritoneal cavity and the lower end of the skin tube to the long saphenous vein. The follow-up period was 4 years. Results. There was no mortality. The complications consisted of hematoma formation in two patients, wound infection in three, and ascitic fluid leakage from the upper anastomosis in three. All these complications were managed conservatively. Conclusion. These findings show that creating a saphenoperitoneal shunt with a skin graft tube interposition is a novel, safe, and cost-effective technique of resolving the problem of refractory ascites.