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Analysis of non-ventriculoperitoneal shunts at Red Cross War Memorial Children's hospital
Background: At Red Cross War Memorial Children's Hospital (RCCH) it is the preferred practice to use non-ventriculoperitoneal (non-VP) shunts when the peritoneum is ineffective or contraindicated for cerebrospinal fluid (CSF) diversion, and when endoscopy is not an option. The objective of this stud...
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| Format: | Thesis |
| Language: | English |
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Division of General Surgery
2024
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| _version_ | 1867613227308810240 |
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| access_status_str | Open Access |
| author | De John, Byron |
| author2 | Enslin, J. M. N. |
| author_browse | De John, Byron Enslin, J. M. N. |
| author_facet | Enslin, J. M. N. De John, Byron |
| author_sort | De John, Byron |
| collection | Thesis |
| description | Background: At Red Cross War Memorial Children's Hospital (RCCH) it is the preferred practice to use non-ventriculoperitoneal (non-VP) shunts when the peritoneum is ineffective or contraindicated for cerebrospinal fluid (CSF) diversion, and when endoscopy is not an option. The objective of this study is to evaluate the clinical course of patients having undergone these procedures. Method: A single centre retrospective review at RCCH wherein forty-three children with a total of 59 episodes of non-VP shunt placement over a 12-year period were identified for inclusion. Results: Twenty-five ventriculoatrial (VA) and 32 ventriculopleural (VPL) shunts were analysed with a median age at insertion of 2,9 (0,3-14,9) and 5,3 years (0,5-13,4) respectively. The median number of previous shunt procedures prior to VA or VPL shunt insertion was 6,0 (2-28) versus 4,5 (2-17) respectively. Three VA (12,0%) and three VPL (9,4%) shunt patients were lost to follow up. Of those remaining, 10 VA shunts (45,5%) compared to 19 (65,5%) VPL shunts required revision. One ventriculovesical and one ventriculocholecystic shunt were placed in the same patient after 21 and 25 shunt related procedures respectively, and both were revised within 3-weeks of insertion. Median shunt survival was 8 months longer for the VA compared to the VPL shunts, being 13,5 (0-67) and 5 months (0-118) respectively. Complications for VA shunts were low, with the overall shunt sepsis rate in the VA group at 4% (n=1) compared to 15,6% (n=5) in the VPL group. Conclusion: Our findings support that VA and VPL shunts are acceptable second-line options in an already compromised group of patients where safe treatment options are limited, provided attention is paid to the technical details specific to their placement. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/39415 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:47.627Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2024 |
| publishDateRange | 2024 |
| publishDateSort | 2024 |
| publisher | Division of General Surgery |
| publisherStr | Division of General Surgery |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/39415 Analysis of non-ventriculoperitoneal shunts at Red Cross War Memorial Children's hospital De John, Byron Enslin, J. M. N. Figaji, A. A. General Surgery Background: At Red Cross War Memorial Children's Hospital (RCCH) it is the preferred practice to use non-ventriculoperitoneal (non-VP) shunts when the peritoneum is ineffective or contraindicated for cerebrospinal fluid (CSF) diversion, and when endoscopy is not an option. The objective of this study is to evaluate the clinical course of patients having undergone these procedures. Method: A single centre retrospective review at RCCH wherein forty-three children with a total of 59 episodes of non-VP shunt placement over a 12-year period were identified for inclusion. Results: Twenty-five ventriculoatrial (VA) and 32 ventriculopleural (VPL) shunts were analysed with a median age at insertion of 2,9 (0,3-14,9) and 5,3 years (0,5-13,4) respectively. The median number of previous shunt procedures prior to VA or VPL shunt insertion was 6,0 (2-28) versus 4,5 (2-17) respectively. Three VA (12,0%) and three VPL (9,4%) shunt patients were lost to follow up. Of those remaining, 10 VA shunts (45,5%) compared to 19 (65,5%) VPL shunts required revision. One ventriculovesical and one ventriculocholecystic shunt were placed in the same patient after 21 and 25 shunt related procedures respectively, and both were revised within 3-weeks of insertion. Median shunt survival was 8 months longer for the VA compared to the VPL shunts, being 13,5 (0-67) and 5 months (0-118) respectively. Complications for VA shunts were low, with the overall shunt sepsis rate in the VA group at 4% (n=1) compared to 15,6% (n=5) in the VPL group. Conclusion: Our findings support that VA and VPL shunts are acceptable second-line options in an already compromised group of patients where safe treatment options are limited, provided attention is paid to the technical details specific to their placement. 2024-04-18T12:54:30Z 2024-04-18T12:54:30Z 2023 2024-04-18T12:29:02Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/39415 eng application/pdf Division of General Surgery Faculty of Health Sciences |
| spellingShingle | General Surgery De John, Byron Analysis of non-ventriculoperitoneal shunts at Red Cross War Memorial Children's hospital |
| thesis_degree_str | Master's |
| title | Analysis of non-ventriculoperitoneal shunts at Red Cross War Memorial Children's hospital |
| title_full | Analysis of non-ventriculoperitoneal shunts at Red Cross War Memorial Children's hospital |
| title_fullStr | Analysis of non-ventriculoperitoneal shunts at Red Cross War Memorial Children's hospital |
| title_full_unstemmed | Analysis of non-ventriculoperitoneal shunts at Red Cross War Memorial Children's hospital |
| title_short | Analysis of non-ventriculoperitoneal shunts at Red Cross War Memorial Children's hospital |
| title_sort | analysis of non ventriculoperitoneal shunts at red cross war memorial children s hospital |
| topic | General Surgery |
| url | http://hdl.handle.net/11427/39415 |
| work_keys_str_mv | AT dejohnbyron analysisofnonventriculoperitonealshuntsatredcrosswarmemorialchildrenshospital |