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The risk of abdominal operations in children with ventriculoperitoneal shunts
T Pittman1, D Williams, T R Weber
1Department of Surgery, St Louis University School of Medicine, MO.
Insights
Children with ventriculoperitoneal (VP) shunts can safely undergo abdominal surgery, even with gastrointestinal or genitourinary tract involvement. This study found minimal risk of shunt infection or malfunction, questioning the need for routine prophylactic antibiotics.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Infectious Disease
Background:
- Ventriculoperitoneal (VP) shunts are standard for pediatric hydrocephalus.
- Abdominal surgeries in these children may risk shunt infection or malfunction.
- Evidence supporting prophylactic antibiotics for these procedures is limited.
Purpose of the Study:
- To evaluate the safety of abdominal operations in children with VP shunts.
- To assess the risk of shunt infection and malfunction after abdominal procedures.
- To determine the necessity of prophylactic antibiotics.
Main Methods:
- Retrospective review of 37 children undergoing 44 abdominal operations.
- Analysis of procedures involving gastrointestinal (GI) or genitourinary (GU) tract opening.
- Examination of antibiotic prophylaxis protocols and outcomes.
Main Results:
- No shunt infections or malfunctions occurred in 1-10 years of follow-up, except one case related to a periappendiceal abscess.
- Abdominal cerebrospinal fluid pseudocysts did not form.
- Antibiotic use varied widely with no clear correlation to outcomes.
Conclusions:
- Children with VP shunts tolerate abdominal operations, including GI/GU procedures, with low risk.
- Current data do not support rigid protocols for prophylactic antibiotics in this setting.
Abstract:
Ventriculoperitoneal (VP) shunts are the operations of choice for patients with hydrocephalus in most pediatric hospitals. Children with VP shunts frequently undergo abdominal operations unrelated to their shunts, which might lead to shunt infections or to malfunctions related to adhesions. Although prophylactic antibiotics are usually used in this setting, there are few data to support their use, or to assess other risks to the shunt from the abdominal procedures. Consequently, we reviewed the records of 37 children with VP shunts who underwent a total of 44 abdominal operations. In 8 cases, the genitourinary (GU) tract was opened (ureteral reimplantation, bladder augmentation, nephrectomy), whereas in 18 patients the gastrointestinal (GI) tract was opened (appendectomy, gastrostomy, small/large bowel resection). In 18 operations neither GI nor GU tract was opened (lysis of adhesions, herniorrhaphy, orchiopexy). Antibiotic coverage was highly variable: 9 received no antibiotics, 9 received antibiotics only postoperatively, 4 were given antibiotics only preoperatively, and in 22 cases antibiotics were given both preoperatively and postoperatively. One shunt that was involved in a periappendiceal abscess was exteriorized and later successfully replaced. In the remaining cases, no episodes of shunt infection or malfunction occurred in 1 to 10 years of follow-up. Likewise, no abdominal cerebrospinal fluid pseudocysts formed as a result of abdominal adhesions. These data demonstrate that children with VP shunts can safely undergo abdominal operations, even when the GI or GU systems are opened, with minimal risk of shunt infection or malfunction. Rigid protocols of prophylactic antibiotics cannot be supported by this series.