Borisova N.A., Andreev G.N., Turmakhanov S.T., Kaumenov E.B., Kashaeva M.D. Veliky Novgorod. Clinical treatment of liver cirrhosis is characterized by polysyndromicity, including syndrome complexes such as portal, lymphatic, and caval hypertension, manifested by vascular insufficiency, and functional liver failure leading to complications such as ascites, esophageal-gastric bleeding, cholestasis, and hypersplenism. The most challenging and unresolved issue is the treatment of cirrhosis complicated by resistant ascites. Given the complex pathogenesis of this disease and the severity of the disease, we consider staging and minimally invasive approaches to be the main treatment principles. Treatment begins with ascitotherapy as a screening method, followed by staged surgical treatment, including pathogenetically targeted, mutually reinforcing surgical interventions sequentially performed on the lymphatic system, endovascular, intra-abdominal ascites-correcting and decompressive surgeries, preferably laparoscopic. Patients in group B with subcompensated liver function undergo external ascitic fluid reinfusion (EAFI) at stage I. Efficiency is 69.3%. If it is ineffective, stage II is performed - peritoneojugular shunting (PUS); if subactivation persists - LVA; stage III - endovascular embolization of the hepatic (EPA) and splenic (ESA) arteries. Stage IV — balloon occlusion of the inferior vena cava (BVOI), endoscopic sclerotherapy (ESCT), or endovascular occlusion (EVO) of esophageal varices for the prevention and treatment of bleeding. Stage V — laparoscopic ascites-correcting and decompressive interventions. In group C, with decompensated liver function, treatment begins with ascites absorption, preferably in combination with external thoracic duct drainage (ETD). Stage II — PUS, LVA; then, in a staged manner, EPA, ESA, BVOI, and videolaparoscopic interventions. In case of bleeding — ETD and a Blakemore catheter, possibly in combination with ESCT. This tactic helps increase operability by 1.5–4 times, reduce postoperative mortality by 5 times, and significantly improve long-term outcomes.