Comparison of Simultaneous and Delayed Ventriculoperitoneal (VP) Shunting in Patients Undergoing Myelomeningocele Repair in Terms of Frequency of Post-Op Shunt Infections

Abstract

Myelomeningocele is frequently associated with hydrocephalus requiring ventriculoperitoneal shunt placement. The optimal timing of shunt insertion remains debated due to concerns about postoperative infection and complications. Objective: To compare the frequency of postoperative ventriculoperitoneal shunt infection between simultaneous ventriculoperitoneal shunt placement and delayed ventriculoperitoneal shunt placement in children undergoing myelomeningocele repair. Methods: A comparative analytical study was conducted at the Department of Neurosurgery, Bahawal Victoria Hospital, Bahawalpur, Pakistan, from June 2025 to September 2025. A total of 154 neonates and children aged two days to five years with myelomeningocele and associated hydrocephalus were enrolled through consecutive sampling. Participants were randomly allocated into two groups. The simultaneous group underwent myelomeningocele repair with ventriculoperitoneal shunt placement during the same operative session, whereas the delayed group underwent myelomeningocele repair followed by shunt placement two weeks later. Preoperative assessment, operative findings, and postoperative monitoring were performed according to standardised clinical and laboratory criteria. Patients were followed for 3 months to detect ventriculoperitoneal shunt infection using clinical features and cerebrospinal fluid analysis. Secondary outcomes included shunt malfunction, cerebrospinal fluid wound leakage, and duration of postoperative hospital stay. Data were analyzed using the chi-square test and independent samples t-test, with a significance level of p < 0.05. Results: The mean age was comparable between groups, and the majority of children were younger than six months. Overall postoperative ventriculoperitoneal shunt infection occurred in 16.2% of patients. Infection was significantly lower in the simultaneous group (11.7%) compared with the delayed group (20.8%). Ventriculoperitoneal shunt malfunction and cerebrospinal fluid leakage showed no statistically significant differences between the groups. The duration of postoperative hospital stay was significantly shorter in the simultaneous shunt placement group. Conclusion: Simultaneous ventriculoperitoneal shunt placement during myelomeningocele repair is associated with a lower infection rate and shorter hospital stay compared with delayed shunt placement. These findings suggest that simultaneous shunting may represent a safer and more efficient surgical strategy for children with myelomeningocele and hydrocephalus.