BACKGROUND Ventriculoperitoneal shunting (VPS) is the mainstay of therapy for hydrocephalus of various causes and is among the most common procedures in pediatric neurosurgery. VPS provides a rapid means to normalize intracranial pressure and can prevent neuronal damage and other detrimental sequelae. Despite its utility, VPS has potential complications that may require additional interventions in order to improve outcome. OBJECTIVE The main objective of the study was to determine the factors affecting surgical outcome following de-novo ventriculoperitoneal shunting. Specifically, the objectives were: 1) To determine the 6-month surgical outcome in hydrocephalic patients who were de-novo treated with ventriculoperitoneal shunting in Lagos University Teaching Hospital. 2) To determine the time-to-failure for each shunt failure 3) To identify factors that are responsible for outcomes METHODS Consecutive patients with hydrocephalus, aged below two years were recruited into the study. Clinical and radiological/laboratory evaluations and peri-operative parameters were evaluated to ascertain their effects on surgical outcome. All study subjects underwent first time VP shunt surgery, and were followed up for 6 months post-operatively. Outcome of interest was shunt failure rate at 6 months. RESULTS Fifty-eight patients (mean age 5.3±0.7 months) were studied. The 6-month shunt failure rate was 20.7% (12/58). The mean time-to-failure was 62.7±16.2 days with a range of 13-172 days. Prior bedside procedure (ventricular tapping) before shunt surgery and post-operative CSF leak were independently associated with shunt failure (p<0.05). A trend of association was observed between nutritional status and 6-month outcome, but this did not reach statistical significance. CONCLUSION The findings of the study indicate that post-operative CSF leak and prior bedside ventricular taps are associated with a higher risk of shunt failure, and has identified the need for more rigorous follow up for the former, and avoidance of pre-operative ventricular taps with respect to the latter.