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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
PubMed
Summary
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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.

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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.