Automated low flow pump system for the treatment of refractory ascites: a single-center experience

TY - JOUR

T1 - Automated low flow pump system for the treatment of refractory ascites: a single-center experience

AU - Thomas, M N

AU - Sauter, G H

AU - Gerbes, A L

AU - Stangl, M

AU - Schiergens, T S

AU - Angele, M

AU - Werner, J

AU - Guba, M

PY - 2015/12

Y1 - 2015/12

N2 - INTRODUCTION: Ascites is a common complication of liver cirrhosis and represents the main cause of hospitalization among patients with cirrhosis. First-line therapy for those patients is the use of diuretics and dietary sodium restriction. However, 10 % of patients per year become therapy refractory to diuretic treatment with the need of repeated high-volume paracentesis or transjugular intrahepatic portosystemic shunt (TIPS). For these patients, an automated pump system (Alfapump/Sequana Medical) was developed. Here, we describe our single-center experience of ten consecutively implanted pump systems.PATIENTS AND METHODS: Between 08/13 and 11/14, ten Alfapump systems were implanted in patients with refractory ascites all suffering from liver cirrhosis. Those patients were treated as a bridge to transplant (4/10) or as an end-stage therapy (6/10). Median follow-up was 165 days (23-379 days).RESULTS: Postimplant, the need of paracentesis could be markedly reduced to a mean of 0.45 (0-4/month) per month. In eight patients, paracentesis was not needed after implantation of the pump system. The median daily output volume was 1000 ml/day (450-2000 ml/day). Prerenal insufficiency was a recurrent complication in the postoperative period.DISCUSSION: The Alfapump system is a useful system in the treatment of patients suffering from therapy refractory ascites. However, due to the high level of comorbidities, careful patient selection and postoperative monitoring are required.

AB - INTRODUCTION: Ascites is a common complication of liver cirrhosis and represents the main cause of hospitalization among patients with cirrhosis. First-line therapy for those patients is the use of diuretics and dietary sodium restriction. However, 10 % of patients per year become therapy refractory to diuretic treatment with the need of repeated high-volume paracentesis or transjugular intrahepatic portosystemic shunt (TIPS). For these patients, an automated pump system (Alfapump/Sequana Medical) was developed. Here, we describe our single-center experience of ten consecutively implanted pump systems.PATIENTS AND METHODS: Between 08/13 and 11/14, ten Alfapump systems were implanted in patients with refractory ascites all suffering from liver cirrhosis. Those patients were treated as a bridge to transplant (4/10) or as an end-stage therapy (6/10). Median follow-up was 165 days (23-379 days).RESULTS: Postimplant, the need of paracentesis could be markedly reduced to a mean of 0.45 (0-4/month) per month. In eight patients, paracentesis was not needed after implantation of the pump system. The median daily output volume was 1000 ml/day (450-2000 ml/day). Prerenal insufficiency was a recurrent complication in the postoperative period.DISCUSSION: The Alfapump system is a useful system in the treatment of patients suffering from therapy refractory ascites. However, due to the high level of comorbidities, careful patient selection and postoperative monitoring are required.

KW - Ascites

KW - Female

KW - Humans

KW - Kidney Function Tests

KW - Length of Stay

KW - Liver Cirrhosis

KW - Liver Function Tests

KW - Male

KW - Operative Time

KW - Paracentesis

KW - Patient Selection

KW - Portasystemic Shunt, Transjugular Intrahepatic

KW - Postoperative Complications

KW - Prostheses and Implants

KW - Treatment Outcome

KW - Journal Article

U2 - 10.1007/s00423-015-1356-1

DO - 10.1007/s00423-015-1356-1

M3 - SCORING: Journal article

C2 - 26566989

VL - 400

SP - 979

EP - 983

JO - LANGENBECK ARCH SURG

JF - LANGENBECK ARCH SURG

SN - 1435-2443

IS - 8

ER -