Techniques and Nuances in Ventriculoperitoneal Shunt Surgery

Ventriculoperitoneal shunt surgery (VPS) is a simple solution to the problem of hydrocephalus. However, it is associated with significant complications. Meticulous attention to a variety of factors, techniques, and nuances in VPS can reduce these complications.

To review the various techniques and nuances during the different stages of VPS.

PubMed search for original and review articles dealing with various techniques used during VPS.

Thorough preoperative planning for VPS reduces operative time and complications. A standardized shunt surgery protocol significantly reduces shunt infection. Good and appropriate surgical technique can enhance the safety of the procedure. Anterior entry point is better than posterior entry point. Shunt tip should be away from choroid plexus, but the exact location is not vital for shunt survival. Proper placement of the shunt in the subgaleal and subcutaneous plane reduces wound and skin breakdown over the shunt. The trocar and laparoscopic methods to access the peritoneum are associated with fewer distal obstructions compared to mini-laparotomy. Perioperative antibiotic prophylaxis, use of antibiotic-impregnated shunts, and sutures are proven techniques to reduce shunt infection.

Preoperative planning, a standardized shunt surgery protocol, good surgical technique, gentle tissue handling, and short surgery duration are essential to reduce VPS complications. Specifically, use of anterior entry point, correct tunneling of the shunt in the subgaleal and subcutaneous plane, appropriate antibiotic prophylaxis, use of antibiotic-impregnated shunts, and meticulous skin closure using antimicrobial sutures can lead to a reduction in shunt malfunction and infection.