Survival Rate and Shunt Infection Incidence Following Gastrostomy in Adult Patients with an Existing Ventriculoperitoneal Shunt

Abstract

Ventriculoperitoneal shunts (VPS) and gastrostomies are frequently provided in daily practice. This study investigated the incidence of VPS infection and the survival rate among adult patients who underwent gastrostomy at least 1 month after VPS placement. This single-center retrospective cohort study was conducted among patients with a VPS, who underwent a gastrostomy. This procedure was performed on a standby basis after a period of at least 1 month had elapsed since VPS placement. Subsequent VPS infection and survival rates were assessed over a period of at least 6 months. We reviewed 31 patients who had a VPS at the time of gastrostomy. Gastrostomy was performed endoscopically in 29 cases and via open surgery in 2 cases. The average interval between VPS insertion and gastrostomy was 1135.5 ± 1717.1 days. A single case of VPS infection (3.2%) was diagnosed during the study. This infection rate was not significantly different than that among 230 patients who underwent their first VPS placement (without gastrostomy) at our institution during the same time period (P = .57); there was also no significant difference in the survival rate, compared to 38 age-matched patients (with cerebrovascular disease, but without a VPS) who underwent gastrostomy (P = .73). Gastrostomy performed after an interval of at least 1 month after VPS placement was extremely safe in adult patients, and their prognosis was excellent. Additional studies are required to develop appropriate nutritional interventions for patients with a VPS.

Safety of laparoscopic cholecystectomy in patients with a cerebrospinal fluid shunt in the peritoneal cavity

“…Respiratory compromise due to subcutaneous emphysema has been reported in a patient who underwent laparoscopic cholecystectomy on day 10 after VPS placement 8 . Furthermore, in a retrospective cohort‐control study, Mawatari et al reported that performing gastrostomy at least 1 month after VPS placement is safe 32 . None of the five shunt patients in whom we performed laparoscopic cholecystectomy underwent shunt intervention and none experienced a shunt‐related complication.…”

“…8 Furthermore, in a retrospective cohort-control study, Mawatari et al reported that performing gastrostomy at least 1 month after VPS placement is safe. 32 None of the five shunt patients in whom we performed laparoscopic cholecystectomy underwent shunt intervention and none experienced a shunt-related complication. Nevertheless, it seems prudent to allow at least 1 month between shunt placement and laparoscopic cholecystectomy.…”

“…Other concerns include shunt dysfunction 4 and shunt infection/retrograde meningitis 5,6 . Several previous case reports have demonstrated the safety of laparoscopic surgery in patients with a VPS or LPS; however, perioperative shunt management has differed between the various reports 7–32 …”

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“…This review examined thirty-one patients and found only a single case of VPS infection (a rate of 3.2%). They reported no statistically significant difference in infection rates compared to patients who received a VPS without a G-tube (p=0.57) or in survival rates of patients with cerebrovascular disease who underwent a G-tube placement without a VPS [29]. The waiting period recommendation of one month had been found amongst other analyses.…”

“…To overcome the acknowledged risks associated with a VPS and concurrent PEG tube placement, a waiting period has been suggested. A 2019 retrospective review concluded that a one-month period between VPS placement and G-tube placement was safe in adult patients with an excellent prognosis [29]. This review examined thirty-one patients and found only a single case of VPS infection (a rate of 3.2%).…”