WOFAPS 2025 8th World Congress of Pediatric Surgery

Hasan Deliağa ¹, Elif Başaran Gündoğdu ², Mehmet Ağar ², Mete Kaya ¹

¹ Department of Pediatric Urology, Health Sciences University, Bursa Yüksek İhtisas Training and Research Hospital
² Department of Neurosurgery, Health Sciences University, Bursa Yüksek İhtisas Training and Research Hospital

OBJECTIVE: To evaluate the effectiveness of ventriculovesical (VV) shunt as a salvage procedure in pediatric hydrocephalus patients who previously failed multiple shunt placements (e.g., VP, VA, VPL) and experienced repeated shunt malfunctions due to extensive intra-abdominal scarring and complications.

MATERIALS AND METHODS: This retrospective case series includes six pediatric patients (5 males, 1 female) treated between 2024–2025 with ventriculovesical shunts after failure of prior shunting routes. The average age at VV shunt surgery was 60.6 months, and patients had histories of multiple VP shunt revisions, and in some cases VA and VPL shunt placements. One patient had a temporary VV shunt removal due to UTI associated with intermittent catheterization (TAK), later re-implanted post-recovery. Etiologies included spinal dysraphism (n=3) and antenatal hydrocephalus (n=3). A total of 7 ventriculovesical procedures were performed on 6 patients. Two patients continue clean intermittent catheterization, and all are on antibiotic prophylaxis.

RESULTS: Mean follow-up was 6.8 months (range: 3–14 months). Currently, all shunts are functioning without complication. No mechanical failures, obstructions, or bladder-related complications (e.g., stones) have been observed to date. In two patients, cranial shunt components were opened due to scalp concerns. One infection-led shunt removal was successfully resolved and re-implanted.

CONCLUSION: Ventriculovesical shunting, although rarely used, presents a viable last-resort option for managing refractory hydrocephalus in patients with abdominal contraindications. Our experience demontrates that with appropriate patient selection, VV shunts can ensure stable, complication-free follow-up, especially in those with multiple abdominal surgeries and limited alternatives. Larger multi-center studies are needed to validate long-term outcomes.