J Korean Neurosurg Soc.  2021 Jan;64(1):120-124. 10.3340/jkns.2020.0088.

Ventriculoperitoneal Shunt without Hair Shaving Using Absorbable Suture Materials

Affiliations
  • 1Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
  • 2Department of Neurosurgery, Catholic Kwandong University College of Medicine, Gangneung, Korea

Abstract


Objective
: Infection is one of most devastating complications in ventriculoperitoneal (VP) shunt surgery. Preoperative hair removal has traditionally been performed to reduce infectious complications. We performed VP shunt surgeries and evaluated the prevalence of infection in patients who were shaved and those who were unshaven.
Methods
: A retrospective analysis was conducted of 82 patients with hydrocephalus of various pathologies who underwent VP shunt surgery, with or without having the head shaved, between March 2010 and March 2017. For patients in the non-shaved group (n=36), absorbable suture materials were used for wound closure, and Nylon sutures or staples were used in the shaved group (n=46). We evaluated the infection outcomes of patients in the two groups.
Results
: There was no difference in the average age of patients in the two groups. In the non-shaved group, there were no infections, while two patients in the shaved group required revision because of shunt infection.
Conclusion
: Non-shaved shunt surgery may be safe and effective, with no increase of infection rate. We recommend that shunt procedures could be performed without shaving the hair, which may increase patients’ satisfaction without increasing infection risk.

Keyword

Ventriculoperitoneal shunt; Hair removal; Infections

Figure

  • Fig. 1. Hair was parted along the proposed incision line (dashed line) with a stapler and secured with elastic bands.


Reference

References

1. Adeleye AO. Nonshaved cranial surgery in black Africans: technical report and a medium-term prospective outcome study. Neurosurg Rev. 39:449–454. 2016.
Article
2. Albright AL, Pollack IF, Adelson PD. Principles and practice of pediatric neurosurger. New York: Thieme;1999.
3. Alexander JW, Fischer JE, Boyajian M, Palmquist J, Morris MJ. The influence of hair-removal methods on wound infections. Arch Surg. 118:347–352. 1983.
Article
4. Bekar A, Korfalı E, Doğan Ş, Yılmazlar S, Başkan Z, Aksoy K. The effect of hair on infection after cranial surgery. Acta Neurochir (Wien). 143:533–536. discussion 537. 2001.
Article
5. Bhatti MI, Leach PA. The incidence of infection for adults undergoing supra-tentorial craniotomy for tumours without hair removal. Br J Neurosurg. 27:218–220. 2013.
Article
6. Braun V, Richter H. Shaving the hair--is it always necessary for cranial neurosurgical procedures? Acta Neurochir (Wien). 135:84–86. 1995.
Article
7. Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 367:2471–2481. 2012.
Article
8. Conen A, Walti LN, Merlo A, Fluckiger U, Battegay M, Trampuz A. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis. 47:73–82. 2008.
Article
9. Iwami K, Takagi T, Arima T, Takayasu M. Cranial surgery without shaving: practice and results in our hospital. No Shinkei Geka. 34:901–905. 2006.
10. Ko W, Lazenby WD, Zelano JA, Isom OW, Krieger KH. Effects of shaving methods and intraoperative irrigation on suppurative mediastinitis after bypass operations. Ann Thorac Surg. 53:301–305. 1992.
Article
11. Lo P, Drake JM. Shunt malfunctions. Neurosurg Clin N Am. 12:695–701. viii. 2001.
Article
12. Orsi GB, Ferraro F, Franchi C. Preoperative hair removal review. Ann Ig. 17:401–412. 2004.
13. Ratanalert S, Musikawat P, Oearsakul T, Saeheng S, Chowchuvech V. Non-shaved ventriculoperitoneal shunt in Thailand. J Clin Neurosci. 12:147–149. 2005.
Article
14. Ratanalert S, Saehaeng S, Sripairojkul B, Liewchanpattana K, Phuenpathom N. Nonshaved cranial neurosurgery. Surg Neurol. 51:458–463. 1999.
Article
15. Ratanalert S, Sriplung H. Social attitudes toward shaving for cranial neurosurgery. Br J Neurosurg. 15:132–136. 2001.
Article
16. Sarmey N, Kshettry VR, Shriver MF, Habboub G, Machado AG, Weil RJ. Evidence-based interventions to reduce shunt infections: a systematic review. Childs Nerv Syst. 31:541–549. 2015.
Article
17. Schreffler RT, Schreffler AJ, Wittler RR. Treatment of cerebrospinal fluid shunt infections: a decision analysis. Pediatr Infect Dis J. 21:632–636. 2002.
Article
18. Tanner J, Moncaster K, Woodings D. Preoperative hair removal: a systematic review. J Perioper Pract. 17:118–132. 118-121, 124-132. 2007.
Article
19. Tanner J, Woodings D, Moncaster K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. (3):CD004122. 2006.
Article
20. Winston KR. Hair and neurosurgery. Neurosurgery. 31:320–329. 1992.
Article
21. Wu X, Liu Q, Jiang X, Zhang T. Prevention options for ventriculoperitoneal shunt infections: a retrospective analysis during a five-year period. Int J Clin Exp Med. 8:19775–19780. 2015.
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