Background: hydrocephulus is defined as increased cerebrospinal fluid production or decreased CSF drainge. It could be managed by ventriculo peritoneal shunt but may be complicated by obstruction or infection, so management could be done through either repeated revision of the peritoneal end or through change it into ventriculo atrial shunt.⁽¹⁾ Purpose:  This work aims to evaluate the efficacy of repeated distal end of ventriculo peritoneal shunt revision in comarison to replacement by ventriculo atrrial shunt.Study design: it is a retrospective study.Patient and methods: this study is a retrospective that includes 60 hydrocephalic Patients with distal end malfunction operated with either repeated revision of distal end (group I) or changed into ventriculo atrial shunt (group II) at neurosurgery department at Benha university and Benha children hospital from January 2018 to January 2020.All patients were examined via detailed general, neurosurgical evaluation and radiological investigations. The patient were followed up with post operative from 12 to 18 months.Results: this study was done on 60 patients with mean age ±SD is 37.22 ±  41.94 months. The outcome of surgery in group I, 14 patients (30.4%) were succeededand 32 patients (69.6%) were failed. In group II, 9 patients (64.3%) were succeeded and 5 patients (35.7%) were failed which is statistically significant.Conclusion: success rate in ventriculoatrial shunt is higher than success rate in repeated ventriculoperitoneal distal revision in repeated distal shunt complication