Development of abdominal pseudocyst in patients which WAS applied ventriculoperitoneal shunt surgery

Ventriculoperitoneal shunt surgery is the most common method used in the treatment of hydrocephalus. Despite advanced technology, complications of ventriculoperitoneal shunt (VPS) surgery sometimes pose serious problems in these patients. Abdominal pseudocyst (APC) formation is a rare but important complication of VPS surgery. In this thesis, patients who underwent VPS surgery were examined in terms of complications of APC development. Patients who underwent VPS surgery in our clinic between January 2006 and June 2020 were reviewed retrospectively. All patients included in our study included their age, gender, presentation complaints, follow-up periods, etiology, comorbidities, time intervals between surgery and APC development, APC sizes, some biochemical parameters in blood and cerebrospinal fluid (CSF) samples, diagnostic methods and the data obtained by evaluating the treatments applied were recorded. Chi-square analysis was used to compare categorical variables between groups. Conformity of continuous variables to normal distribution was evaluated with the Shapiro-Wilk test. In the comparison of the paired groups, the Student's T test was used for the variables with normal distribution, and the Mann Whitney U test was used for the variables which did not fit the normal distribution. The statistical significance level in the analyzes was accepted as p<0.05. Of the 1578 patients who underwent VPS surgery, 25 (1.58%) patients who developed APC during their follow-up were included in the study. Seventeen (68%) of the cases were pediatric and 8 (32%) were in the adult age group. The mean age was found to be 15 years. The youngest patient was 5 months old, and the oldest patient was 73 years old. Again, 10 (40%) of the patients were male and 15 (60%) were female. The mean time between VPS surgery and the development of APK was 4.9 years, with the shortest 12 days and the longest 21.6 years. Neural tube defects were present in 17 of the patients. Since 3 patients were asymptomatic, they were followed up with conservative treatment. The cysts of 7 patients with infection were evacuated, external ventricular drainage was performed simultaneously, and antibiotic treatmentwas started. In 15 patients, the cyst was evacuated by laparoscopic or open surgery and the abdomen was directed to a different area. Recurrence was observed in 2 patients in the follow-up, and ventriculoatrial shunt was changed in one of these patients and ventriculoatrial shunt in the other. APC is a rare but important cause of shunt dysfunctions, and there are very few studies with large series on this subject. When patients undergoing VPS surgery present with abdominal complaints, APC should be kept in mind, and a rapid diagnosis and treatment should be decided by ultrasonography. High CSF protein and high PLT may be risk factors for APC formation. Key words: Hydrocephalus, abdominal pseudocyst, ventriculoperitoneal shunt surgery.