Lumboperitoneal shunts: review of 409 cases.

BACKGROUND AND AIMS: A prospective study was carried out to evaluate the lumboperitoneal shunt procedure. MATERIAL AND METHODS: Four hundred and nine patients having communicating hydrocephalus were selected for the procedure during a 10-year period from March 1992 to February 2002. The average follow-up was 45.34 months. RESULTS: Tubercular meningitis (TBM)-related hydrocephalus was detected in 285 patients. Forty per cent of the patients were less than 15 years of age. Glasgow Coma Scale (GCS) of less than 8 was seen in 40% patients and 14.9% patients were in GCS 13-15. At the time of discharge 56.7% patients improved in their GCS to 13 -15 and 14.9% were in GCS 8 or less. The overall mortality was 5.13% and shunt-related mortality was seen in 2% patients. Shunt malfunction requiring revision was seen in 32 patients (7.8%) and the total number of shunt revisions was 44 (11%). Shunt infection was noted in 3.4% patients. CSF leak at the lumbar end occurred in 12 patients. Four patients required conversion of LP shunt to VP shunt. CONCLUSIONS: Lumboperitoneal shunt is an effective shunting procedure in communicating hydrocephalus.

Esophago-gastric dissociation complicating devascularization procedure for portal hypertension.

Devascularization surgery for portal hypertension, indicated in selected patients, is considered safe. A 15-year-old boy with cirrhosis underwent elective modified Sugiura's devascularization procedure for secondary prophylaxis of variceal bleeding. He developed esophago-gastric dissociation, which was successfully managed with emergency feeding jejunostomy and restoration of gut continuity three months later.