Ventriculoperitoneal shunt surgery in a Nigerian city. A single institutional experience.

Introduction. Improvements in surgical techniques and advancements in antibiotic management have significantly reduced the complications associated with Ventriculoperitoneal Shunting which is still the most common procedure for the treatment of hydrocephalus. These complications are believed to be highest in Low and middle-income countries due to delayed presentation to care facilities. The authors report our experience of managing paediatric hydrocephalus in an institution with evolving Neurosurgical practice in North Central Nigeria. Material and methods. We retrospectively reviewed all cases of VP shunting from 2011 to 2018 taking into consideration the demographics, aetiologies of hydrocephalus, length of hospital stay, postoperative morbidity and mortality, and overall outcome. Complications sought included, Surgical Site infections, shunt exposure, obstruction or any other cause of shunt malfunction. The minimum follow-up period was 24 months Results. There were 27 VPS procedures done in 25 patients of whom 15 were males and 10 females (M:F ratio of 1.5:1). The age range was 8 days to 9 years with a median age of 5 months. Of the 25 cases, 24 (96%) were non-tumoral in origin comprising 17 congenital and 7 acquired hydrocephalus. At 2 years post shunt insertion, 21 (84%) of the 25 initial cases were still functional. The total complication rate was 28%, comprising Surgical Site infection, shunt exposure, shunt obstruction, seizure, and one death, There were 3 (12%) shunt failures from shunt obstruction (2) and shunt exposure (1). Conclusion With meticulous control of the surgical environment and improved experience in ventriculoperitoneal shunting, the complication rate can be significantly reduced. There is a need to increase the awareness of the population to the availability of care for seemingly hopeless conditions. The burden of the cost of care on individuals should be lightened through better health insurance coverage. [ABSTRACT FROM AUTHOR]

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