title: Placement of the peritoneal end of a ventriculoperitoneal shunt in the suprahepatic space: does it improve prognosis?
abstract: BACKGROUND
  Hydrocephalus is a common pediatric problem. Ventriculoperitoneal shunts (VPS) are the most frequent operative procedures used to treat hydrocephalic children. The peritoneal end is usually placed in the general peritoneal cavity. We present an alternative site of peritoneal end placement in the suprahepatic space in an attempt to reduce the abdominal complications.
  
  
  METHODS
  All patients with a diagnosis of congenital hydrocephalus were included in the study. In group 1, the lower end of the VPS was placed in the suprahepatic space. Patients were evaluated for abdominal complications like pseudocyst formation, intestinal obstruction and blockage of the lower end of the VPS. The data were compared with those patients in whom the peritoneal end was placed in the general peritoneal cavity (group 2).
  
  
  RESULTS
  The total number of patients in groups 1 and 2 was 133 and 175, respectively. Complications in group 1 were dislodgement of the shunt in the general peritoneal cavity in 28 (21.05%), suprahepatic pseudocyst formation in 2 (1.5%) and blocked lower end in 2 patients (1.5%). In group 2, complications noted were pseudocyst formation in 5 (2.8%), blocked lower end in 25 (14.2%), intestinal obstruction in 9 (5.1%), inguinoscrotal migration in 10 (5.7%) and perforation of viscera in 6 patients (3.4%). The overall follow-up period ranged from 1 to 7 years.
  
  
  CONCLUSIONS
  Placement of the lower end of the shunt in the suprahepatic space can be advantageous to placing it in the general peritoneal cavity. The procedure is simple and results can be rewarding.
authors.affiliation: Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
authors.forename: A
authors.initials: A
authors.lastname: Pandey
authors.forename: A N
authors.initials: AN
authors.lastname: Gangopadhyay
authors.forename: S P
authors.initials: SP
authors.lastname: Sharma
authors.forename: V D
authors.initials: VD
authors.lastname: Upadhyaya
authors.forename: V
authors.initials: V
authors.lastname: Kumar
authors.forename: S C
authors.initials: SC
authors.lastname: Gopal
authors.forename: D K
authors.initials: DK
authors.lastname: Gupta
authors.forename: A
authors.initials: A
authors.lastname: Srivastava
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D008099:Liver; D008297:Male; D010529:Peritoneal Cavity / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt / Q000379:methods*