Purpose of review <p>This systematic review and meta-analysis aimed to evaluate the safety and efficacy of permanent peritoneal catheters (PPC) and peritoneal ports (PP) in patients with refractory ascites of malignant and non-malignant etiology, irrespective of etiology, and to compare these devices to large-volume paracentesis (LVP).</p> Recent findings <p>Twenty-nine studies were included, with the majority being case series. Meta-analysis found no significant difference in peritonitis risk between PPC/PP and LVP. Cellulitis, occlusion, and ascites leakage were variably reported across studies. Average catheter patency was approximately 72 days. Quality of life improvements were reported in only a subset of studies, with considerable heterogeneity in assessment tools and limited standardization of definitions and prophylaxis protocols.</p> Summary <p>Despite substantial heterogeneity and risk of bias across included studies, no significant differences in safety were observed between PPC/PP and LVP. Available evidence suggests these devices may offer practical advantages in symptom control and could reduce the need for repeated paracentesis in selected patients. However, further randomized studies are needed to standardize protocols and better guide clinical implementation.</p> Funding <p>This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.</p> Registration <p>This protocol was register with PROSPERO (CRD42024622692).</p>