title: Use of Antifibrotics to Prevent Ventriculoperitoneal Shunt Complications Due to Intra-abdominal Fibrosis: Experimental Study in a Rat Model.
abstract: BACKGROUND
  Cerebrospinal fluid shunt operations have reduced the morbidity and mortality of hydrocephalus, but have potential complications. Ventriculoperitoneal (vp) shunt obstruction is one of the common complications of shunt surgery. The obstruction is caused by fibrosis and is usually located on the tip of the ventricular and/or peritoneal catheter.
  
  
  OBJECTIVE
  In our study, we aimed to demonstrate the known antifibrotic effects of heparin, hyaluronate/carboxymethylcellulose, and icodextrin on peritoneal catheter obstruction in a vp shunt model in rats.
  
  
  METHODS
  Thirty-two male Sprague-Dawley rats were used in this study. A shunt catheter was placed in the abdominal cavity. In the control group, isotonic solution, in the study groups, heparin, sodium hyaluronate/carboxymethylcellulose (HA/CMC), and icodextrin were intraperitoneally applied. The severity of adhesions and inflammation around the peritoneal catheter was evaluated after the rats were killed on day 30.
  
  
  RESULTS
  One animal in the heparin group died due to intra-abdominal hemorrhage. We found the most adhesions in the control group. All three drugs (heparin, HA/CMC, icodextrin) were effective for adhesion prevention. HA/CMC was more effective than heparin, and icodextrin was most effective. There was a statistically significant difference between the icodextrin and the control group (p = 0.007).
  
  
  CONCLUSIONS
  The intra-abdominal instillation of icodextrin, HA/CMC, and heparin, especially icodextrin, can decrease the rate of vp shunt dysfunction by preventing formation of intraperitoneal fibrosis.
authors: Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
authors: Aydın
authors: A
authors: Aydoseli
authors: Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
authors: Alican
authors: A
authors: Tahta
authors: Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
authors: Yavuz
authors: Y
authors: Aras
authors: Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
authors: Akın
authors: A
authors: Sabancı
authors: Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
authors: Metin
authors: M
authors: Keskin
authors: Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
authors: Emre
authors: E
authors: Balik
authors: Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
authors: Semen
authors: S
authors: Onder
authors: Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
authors: Altay
authors: A
authors: Sencer
authors: Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
authors: Nail
authors: N
authors: Izgi
mesh_terms: D000818:Animals; D002266:Carboxymethylcellulose Sodium / Q000008:administration & dosage / Q000494:pharmacology; D015314:Dialysis Solutions / Q000008:administration & dosage / Q000494:pharmacology; D004195:Disease Models, Animal; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D005936:Glucans / Q000008:administration & dosage / Q000494:pharmacology; D005947:Glucose / Q000008:administration & dosage / Q000494:pharmacology; D006493:Heparin / Q000008:administration & dosage / Q000494:pharmacology; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000494:pharmacology; D000077607:Icodextrin; D054368:Laxatives / Q000008:administration & dosage / Q000494:pharmacology; D008297:Male; D056627:Peritoneal Fibrosis / Q000517:prevention & control*; D051381:Rats; D017207:Rats, Sprague-Dawley; D000267:Tissue Adhesions / Q000517:prevention & control*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D055675:Viscosupplements / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D015314:Dialysis Solutions; D005343:Fibrinolytic Agents; D005936:Glucans; D054368:Laxatives; D055675:Viscosupplements; D000077607:Icodextrin; D006820:Hyaluronic Acid; D006493:Heparin; D005947:Glucose; D002266:Carboxymethylcellulose Sodium