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The non-functioning pleuro-peritoneal shunt: revise or replace?
K M al-Kattan1, D K Kaplan, P Goldstraw
1Royal Brompton Hospital, London, U.K.
The Thoracic and Cardiovascular Surgeon
|October 1, 1994
Summary
For recurrent pleural effusions due to malignancy, pleuro-peritoneal shunts (PPS) can palliate symptoms. Replacing malfunctioning shunts, rather than revising them, is recommended to ensure continued function and improve patient outcomes.
Area of Science:
- Oncology
- Thoracic Surgery
- Palliative Care
Background:
- Pleural malignancy frequently causes recurrent, troublesome effusions.
- Effective palliation is crucial given the short median survival (2-3 months).
- Pleuro-peritoneal shunts (PPS) have been used for palliation, but 11% malfunction.
Purpose of the Study:
- To revise management strategies for non-functioning pleuro-peritoneal shunts (PPS).
- To evaluate the outcomes of revision versus replacement for malfunctioning PPS.
Main Methods:
- A retrospective study of 70 patients requiring 71 PPS insertions over seven years.
- Analysis of 8 cases (11%) of non-functioning shunts requiring re-exploration.
- Categorization of shunt failures (infection, obstruction, fibrinous blockage) and intervention outcomes.
Main Results:
- Eight non-functioning shunts (11%) necessitated re-exploration.
- Infection led to shunt removal and drainage in two cases.
- Revision of three fibrinous-blocked shunts failed, while replacement in two others restored function; subsequent replacement after re-blockage also restored function.
Conclusions:
- Non-functioning pleuro-peritoneal shunts (PPS) present a management challenge.
- Shunt replacement is more effective than revision for restoring function.
- Replacing malfunctioning PPS avoids complications and ensures continued palliation.