Cervical lymphato-venous shunt in treatment of ascites in caval-constricted dogs and in patients with hepatic cirrhosis. Experimental observations and 7 years clinical experience.

In experimental ascites produced by inferior vena caval constriction there is a pressure gradient at the thoracic duct-venous junction suggesting a functional obstacle to lymph flow. Abdominal fluid and protein are transported mainly by the right lymph trunk and not by the thoracic duct. External drainage of the thoracic duct or construction of a new, wider thoracic duct-venous anastomosis facilitates, however, transport of excess capillary filtrate formed in the liver and decreases fluid spillage into the peritoneal cavity. Construction of a cervical lymphato-venous anastomosis was attempted in 21 patients, 20 of whom had cirrhosis, and the operation was technically successful in 16 cases. Operation was helpful in cirrhotic patients with rapid ascites formation, who required less frequent abdominal paracenteses operation. The shunt was without benefit in prevention of oesophageal varix bleedings, and it should not be attempted in patients with icterus and severe deterioration of liver function.