Introduction: Ventriculoperitoneal shunt (VPS) placement is a common procedure for treating hydrocephalus (1). However, VPS malfunction, a frequent complication, often requires re-intervention (2,3), whether it´s distally, proximally, or both. Some of the most common surgeries involve the abdominal and urological regions. The question regarding measures needed to be applied with the distal catheter are unanswered, furthermore, the literature regarding patients with VPS that undergo these surgeries is very limited. This review of the literature aims to evaluate patients with VPS undergoing abdominal or urological procedures, the outcomes and approach used regarding the catheter.
Methods: PubMed and Google Scholar databases were searched using the keywords "ventriculoperitoneal shunt/VPS and surgery", "postoperative complications:", "antibiotics". Nonexperimental, nonanimal, english written studies about postoperative complications of patients with a VPS were considered. We evaluate the age, sex, which surgical procedure was done, signs of elevated ICP intra or postoperatively, any previous revision, externalization, removal or replacement, VPS infection postoperatively, and pre and postoperative antibiotic coverage.
Results: Out of 1,220 studies identified, 28 were included. We analyzed a total of 269 patients; 129 (48%) adults, 130 (48.3%) pediatrics, and 10 (3.7%) not specified. The ICP was intraoperatively measured in only 4 (1.5%) patients, 132 (49.1%) did not specify and 133 (49.4%) had no clinical signs of elevated ICP. Shunt revision, removal, or replacement was required in 26 (8.7%) patients. Preoperative antibiotics were given to 161 patients (60%) and postoperative antibiotics to 141 (52.4%). Infectious focus was presented in 16 (6%) of patients. Only 8 (3%) patients had a shunt infection postoperatively.
Conclusion : Preventing VPS complications such as infections is challenging. Externalization might reduce infection risks in certain cases, furthermore, our findings suggest that laparoscopic surgery may lower infection risks compared to open surgery, while infectious foci or perforations can increase malfunction risks. Additionally, perioperative antibiotics may reduce VPS malfunction likelihood.
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