Elective intraperitoneal procedures do not adversely impact paediatric ventriculoperitoneal shunt survival: 10-year retrospective cohort study

Abstract

INTRODUCTION: There is currently little evidence to guide the management of ventricular-peritoneal shunts during subsequent intraperitoneal procedures, and the influence of these procedures on the risk of shunt malfunction is poorly understood. METHODS: A ten-year single institution retrospective analysis was undertaken to identify all paediatric patients with ventriculoperitoneal shunts. Statewide electronic medical records were reviewed to determine whether the patient had undergone any subsequent intraperitoneal procedures, and if so, how the shunt was managed during the procedure. Intraperitoneal procedures were divided into elective and emergency categories. Shunt survival was compared with patients not undergoing subsequent intraperitoneal procedures in time-dependent univariate and multivariate Cox proportional hazard models. RESULTS: A total of 1084 shunt-related procedures were performed in 472 patients, of which 45 patients underwent elective and 15 patients underwent emergency intraperitoneal procedures during a mean follow-up of 4.85 years. The most common elective procedures were considered 'clean' procedures-gastrostomies 17 (38%) and hernia repairs 13 (29%), in addition to 8 (18%) 'clean-contaminated' colostomy or colectomy procedures. No significant association of elective intraperitoneal procedures with earlier shunt failure was found on univariate or multivariate analysis (HR 1.18, 95% CI 0.57-2.44, p = 0.66). Of patients presenting with an acute abdomen requiring surgical intervention, 4/15 (27%) were secondary to shunt infection, which increases to 4/6 (66%) in those without a clear preoperative alternative diagnosis. CONCLUSION: The performance of an elective intra-peritoneal procedure on a patient with a ventriculoperitoneal shunt in situ does not appear to increase the risk of subsequent shunt malfunction.