J Neurol Surg A Cent Eur Neurosurg 2015; 76(03): 219-223
DOI: 10.1055/s-0034-1389369
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Use of Antifibrotics to Prevent Ventriculoperitoneal Shunt Complications Due to Intra-abdominal Fibrosis: Experimental Study in a Rat Model

Aydın Aydoseli
1   Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
Alican Tahta
1   Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
Yavuz Aras
1   Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
Akın Sabancı
1   Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
Metin Keskin
2   Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
Emre Balik
2   Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
Semen Onder
3   Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
Altay Sencer
1   Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
Nail Izgi
1   Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

09 November 2013

23 May 2014

Publication Date:
26 March 2015 (online)


Background Cerebrospinal fluid shunt operations have reduced the morbidity and mortality of hydrocephalus, but have potential complications. Ventriculoperitoneal (vp) shunt obstruction is one of the common complications of shunt surgery. The obstruction is caused by fibrosis and is usually located on the tip of the ventricular and/or peritoneal catheter.

Objective In our study, we aimed to demonstrate the known antifibrotic effects of heparin, hyaluronate/carboxymethylcellulose, and icodextrin on peritoneal catheter obstruction in a vp shunt model in rats.

Methods Thirty-two male Sprague-Dawley rats were used in this study. A shunt catheter was placed in the abdominal cavity. In the control group, isotonic solution, in the study groups, heparin, sodium hyaluronate/carboxymethylcellulose (HA/CMC), and icodextrin were intraperitoneally applied. The severity of adhesions and inflammation around the peritoneal catheter was evaluated after the rats were killed on day 30.

Results One animal in the heparin group died due to intra-abdominal hemorrhage. We found the most adhesions in the control group. All three drugs (heparin, HA/CMC, icodextrin) were effective for adhesion prevention. HA/CMC was more effective than heparin, and icodextrin was most effective. There was a statistically significant difference between the icodextrin and the control group (p = 0.007).

Conclusion The intra-abdominal instillation of icodextrin, HA/CMC, and heparin, especially icodextrin, can decrease the rate of vp shunt dysfunction by preventing formation of intraperitoneal fibrosis.

  • References

  • 1 Bondurant CP, Jimenez DF. Epidemiology of cerebrospinal fluid shunting. Pediatr Neurosurg 1995; 23 (5) 254-258 ; discussion 259
  • 2 Liptak GS, McDonald JV. Ventriculoperitoneal shunts in children: factors affecting shunt survival. Pediatr Neurosci 1985- 1986; 12 (6) 289-293
  • 3 Tuli S, Drake J, Lawless J, Wigg M, Lamberti-Pasculli M. Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg 2000; 92 (1) 31-38
  • 4 McGirt MJ, Leveque JC, Wellons III JC , et al. Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience. Pediatr Neurosurg 2002; 36 (5) 248-255
  • 5 Grosfeld JL, Cooney DR, Smith J, Campbell RL. Intra-abdominal complications following ventriculoperitoneal shunt procedures. Pediatrics 1974; 54: 791-796
  • 6 Kutlay J, Ozer Y, Isik B, Kargici H. Comparative effectiveness of several agents for preventing postoperative adhesions. World J Surg 2004; 28 (7) 662-665
  • 7 Martin K, Baird R, Farmer JP , et al. The use of laparoscopy in ventriculoperitoneal shunt revisions. J Pediatr Surg 2011; 46 (11) 2146-2150
  • 8 Hon WC, Lai PS, Chien YH , et al. Single-incision laparoscopic surgery (SILS) for ventriculoperitoneal shunt placement. J Neurol Surg A 2013; 74: 351-356
  • 9 Kement M, Censur Z, Oncel M, Buyukokuroglu ME, Gezen FC. Heparin for adhesion prevention: comparison of three different dosages with Seprafilm in a murine model. Int J Surg 2011; 9 (3) 225-228
  • 10 Diamond MP, Burns EL, Accomando B, Mian S, Holmdahl L. Seprafilm® adhesion barrier: (1) a review of preclinical, animal, and human investigational studies. Gynecol Surg 2012; 9 (3) 237-245
  • 11 Trew G, Pistofidis G, Pados G , et al. Gynaecological endoscopic evaluation of 4% icodextrin solution: a European, multicentre, double-blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery. Hum Reprod 2011; 26 (8) 2015-2027
  • 12 Holmdahl L. Making and covering of surgical footprints. Lancet 1999; 353 (9163) 1456-1457
  • 13 Thompson JN, Whawell SA. Pathogenesis and prevention of adhesion formation. Br J Surg 1995; 82 (1) 3-5
  • 14 Ray NF, Larsen Jr JW, Stillman RJ, Jacobs RJ. Economic impact of hospitalizations for lower abdominal adhesiolysis in the United States in 1988. Surg Gynecol Obstet 1993; 176 (3) 271-276
  • 15 Oncel M, Remzi FH, Senagore AJ, Connor JT, Fazio VW. Comparison of a novel liquid (Adcon-P) and a sodium hyaluronate and carboxymethylcellulose membrane (Seprafilm) in postsurgical adhesion formation in a murine model. Dis Colon Rectum 2003; 46 (2) 187-191
  • 16 Zeng Q, Yu Z, You J, Zhang Q. Efficacy and safety of Seprafilm for preventing postoperative abdominal adhesion: systematic review and meta-analysis. World J Surg 2007; 31 (11) 2125-2131 ; discussion 2132
  • 17 Verco SJS, Peers EM, Brown CB, Rodgers KE, Roda N, diZerega G. Development of a novel glucose polymer solution (icodextrin) for adhesion prevention: pre-clinical studies. Hum Reprod 2000; 15 (8) 1764-1772
  • 18 diZerega GS, Verco SJ, Young P , et al. A randomized, controlled pilot study of the safety and efficacy of 4% icodextrin solution in the reduction of adhesions following laparoscopic gynaecological surgery. Hum Reprod 2002; 17 (4) 1031-1038
  • 19 Davies D. Kinetics of Icodextrin. Perit Dial Int 1994; 14: S45-S50
  • 20 Hosie K, Gilbert JA, Kerr D, Brown CB, Peers EM. Fluid dynamics in man of an intraperitoneal drug delivery solution: 4% icodextrin. Drug Deliv 2001; 8 (1) 9-12
  • 21 Brown CB, Luciano AA, Martin D, Peers E, Scrimgeour A, diZerega GS ; Adept Adhesion Reduction Study Group. Adept (icodextrin 4% solution) reduces adhesions after laparoscopic surgery for adhesiolysis: a double-blind, randomized, controlled study. Fertil Steril 2007; 88 (5) 1413-1426
  • 22 Leach RE, Henry RL. Reduction of postoperative adhesions in the rat uterine horn model with poloxamer 407. Am J Obstet Gynecol 1990; 162 (5) 1317-1319
  • 23 Bryant MS, Bremer AM, Tepas III JJ, Mollitt DL, Nquyen TQ, Talbert JL. Abdominal complications of ventriculoperitoneal shunts. Case reports and review of the literature. Am Surg 1988; 54 (1) 50-55
  • 24 Otake K, Uchida K, Inoue M , et al. Efficacy of Seprafilm® in abdominal surgery for ventriculoperitoneal shunt malfunction: a report of two pediatric cases. Pediatr Neurosurg 2011; 47 (3) 214-216
  • 25 Yu S, Bensard DD, Partrick DA, Petty JK, Karrer FM, Hendrickson RJ. Laparoscopic guidance or revision of ventriculoperitoneal shunts in children. JSLS 2006; 10 (1) 122-125
  • 26 Naftel RP, Argo JL, Shannon CN , et al. Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases. J Neurosurg 2011; 115 (1) 151-158
  • 27 de Aquino HB, Carelli EF, Borges Neto AG, Pereira CU. Nonfunctional abdominal complications of the distal catheter on the treatment of hydrocephalus: an inflammatory hypothesis? Experience with six cases. Childs Nerv Syst 2006; 22 (10) 1225-1230
  • 28 Beck DE, Cohen Z, Fleshman JW, Kaufman HS, van Goor H, Wolff BG ; Adhesion Study Group Steering Committee. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum 2003; 46 (10) 1310-1319
  • 29 Scott FI, Osterman MT, Mahmoud NN, Lewis JD. Secular trends in small-bowel obstruction and adhesiolysis in the United States: 1988–2007. Am J Surg 2012; 204 (3) 315-320