Management of sterile abdominal pseudocysts in the context of ventriculoperitoneal shunts: a systematic review

This systematic review investigates the management of sterile abdominal pseudocysts (APCs), a complication associated with ventriculoperitoneal shunts (VPS). Management options for sterile APCs include repositioning and externalization, but there remains no consensus on which management technique is superior in terms of outcomes in recurrence or overall complication rates. Therefore, a comparison of outcomes between shunt externalization and repositioning was conducted. A systematic review was done through PRISMA guidelines, and a search of multiple databases, including Medline and Embase, was conducted from the date of inception until 2023. The search results demonstrated 382 articles. Of the 382 articles, 252 were unique, and 43 articles were included in the analysis after full-text analysis. The results of our analysis indicate there is no significant difference in pseudocyst recurrence and overall complications between externalization and repositioning of the distal shunt catheter. The rate of pseudocyst recurrence for studies with a follow-up of 6 or more months was 25% and 24.1% for repositioning and externalization, respectively (p = 0.99). The overall complication rate for studies with a follow-up of 6 or more months was 44.4% and 34.5% for repositioning and externalization, respectively (p = 0.3861). Although our analysis did not demonstrate a significant difference between the two approaches, further work that includes prospective studies, longer follow-up periods, and larger sample sizes is needed to establish this.