Ventriculoperitoneal Shunt Distal Dysfunction Due to Peritoneal Malabsorption: Etiologies and Management Strategies—An Institutional Review

Purpose This study aims to investigate the etiology, risk factors, and management outcomes of peritoneal malabsorption, including pseudocysts and non-hepatic ascites, as a complication of ventriculoperitoneal (VP) shunting in pediatric hydrocephalus patients, with a focus on identifying predictors of distal dysfunction and evaluating therapeutic strategies. Methods A retrospective review was conducted on 81 pediatric patients (≤ 18 years) undergoing 113 VP shunt revision surgeries at Akdeniz University Hospital (2019–2023). Variables included age, sex, catheter site, hydrocephalus type, revision history, axial deformity severity, and abdominal surgery history. Peritoneal malabsorption cases (n = 11) were analyzed for risk factors and management outcomes, with a minimum 9-month follow-up using ultrasonography and CT scans. Results Peritoneal malabsorption occurred in 10 patients (11 cases), with significant risk factors including a history of multiple revision surgeries (OR 8.021, 95% CI 1.858–34.627, p = 0.002), prior abdominal surgery (OR 11.813, 95% CI 2.73–51.04, p = 0.001), and axial deformity (OR 4.071, 95% CI 1.034–16.031, p = 0.034), with a 2.77-fold increase in odds per severity level (95% CI 1.12–6.85, p = 0.027). Management strategies included catheter replacement after 2–4 weeks of externalization (3/6 successful), adhesiolysis with immediate reimplantation (1/4 successful), subdiaphragmatic placement (1/1 successful), and VA shunts in 3 cases. Conclusion This study identifies novel risk factors for peritoneal malabsorption in VP shunts, including surgical history and axial deformity, suggesting mechanical and inflammatory contributions. Management remains challenging, with variable success rates, highlighting the need for preoperative risk assessment and larger studies to refine therapeutic strategies.