Evaluation of Perioperative Management and Surgical Procedures of Augmentation Cystoplasty in Patients With Spina Bifida and V-P Shunt

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  • V-Pシャントを有する二分脊椎患者に対する消化管利用膀胱拡大術の周術期管理
  • V Pシャント オ ユウスル 2ブン セキツイ カンジャ ニ タイスル ショウカカン リヨウ ボウコウ カクダイジュツ ノ シュウジュツキ カンリ

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Abstract

Purpose: Augmentation cystoplasty in patients with spina bifida is widely accepted. However V-P shunt infection is a fatal complication, so we need careful attention to prevent it especially in procedures involving an open gastrointestinal and urinary tract. But perioperative management to prevent shunt infection is not standardized. We evaluate and report the rate of shunt infection and perioperative management of our experience. Methods: From 2005 January to 2007 March, we performed 6 augmentation cystoplasties in patients with spina bifida and V-P shunt. Mean age was 13 y.o. (5-17 y.o.). Surgical materials were ileum in 5, sigmoid colon in 1. Mean follow up period was 1y9m (10m-3y). We retrospectively reviewed and evaluated the rate of shunt infection, method of bowel preparation, duration of antibiotics, surgical procedures, duration of drain indwelling and results of culture. Results: We experienced no shunt infection. Preoperatively 5 had positive urine culture but after using prophylactic antibiotics, all 6 had negative urine culture on the operation day. All patients received bowel preparation using GOLYTELY. Intravenous broad-spectrum antibiotics were initiated 12 hours preoperatively and continued for 3 days at most. Afterward all patients received oral prophylactic antibiotics. Drains were removed on POD2. After operation all cultures were negative. Conclusions: The rate of shunt infection was 0%. Routine preoperative V-P shunt revision is unnecessary. A short-time use of intravenous broad-spectrum antibiotics, early drain removal and control of preoperative urinary tract infection are important to prevent shunt infection.

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