Elsevier

Journal of Surgical Research

Volume 236, April 2019, Pages 119-123
Journal of Surgical Research

Pediatric Surgery
Do Ventriculoperitoneal Shunts Increase Complications After Laparoscopic Gastrostomy in Children?

https://doi.org/10.1016/j.jss.2018.10.027Get rights and content

Abstract

Background

In patients requiring gastrostomies, ventriculoperitoneal (VP) shunts are a frequently encountered comorbidity. The objective of this study is to evaluate the postoperative management of children with VP shunts that undergo laparoscopic gastrostomy placement and determine their incidence of complications.

Materials and methods

Children 18 y old or younger who underwent laparoscopic gastrostomy placement at a freestanding academic children's hospital between January 2014 and October 2016 were reviewed. Data collected included demographics, management, and outcomes. Patients were compared based on their presence of a VP shunt before laparoscopic gastrostomy. Statistical analysis was performed using chi square, Fisher's exact, and Wilcoxon rank-sum tests.

Results

We reviewed the medical records of 270 children that underwent laparoscopic gastrostomy placement by 15 pediatric surgeons. Of these, 9% (25) had a previously placed VP shunt. In comparing patients with a VP shunt with those without a VP shunt, there was no significant difference in median age (4 versus 3 y, P = 0.92), gender (48% versus 51% males, P = 0.80), body mass index (15 versus 16, P = 0.69), preoperative diet (48% versus 47% nasogastric tube dependent, P = 0.60), or procedure time (43 versus 42 min, P = 0.37). The postoperative management of these children was similar: day of initiation of postoperative feeds (84% versus 73% on postoperative day #1, P = 0.70), method of initiation of feeds (60% versus 55% continuous, P = 0.25), and type of initial feeds (83% versus 71% Pedialyte, P = 0.24). Similarly, there was no difference in hospital length of stay, return to the emergency department, or postoperative complications within 90 d (P > 0.05).

Conclusions

Children with ventriculoperitoneal shunts do not have a higher rate of immediate complications after laparoscopic gastrostomy placement and may be managed similar to other children in the postoperative period.

Introduction

Laparoscopic gastrostomy tube placement was introduced in the 1990s and is one of the most common procedures performed in children. In 2006, an estimated 11,000 gastrostomy tubes were placed in children less than 18 y of age in the United States.1 Laparoscopic gastrostomy is a safe and frequently performed procedure for patients who are incapable of sufficient oral intake. Gastrostomy feeds has become the method of choice for providing nutrition to children who require long-term nutritional support.2, 3 Given the association of neurologic disorders and swallowing difficulties, gastrostomies are frequently needed in patients with ventriculoperitoneal (VP) shunts.

The presence of a VP shunt in children undergoing gastrostomy placement raises concerns regarding VP shunt integrity or infections as well as increased operative complexity. The postoperative course of these children may differ as well, and their rate of complications postoperatively is unknown. Currently, there is a paucity of data on the outcomes of children with VP shunts who undergo gastrostomy placement. The literature is conflicting with regard to the safety of percutaneous endoscopic gastrostomies and the literature addressing the laparoscopic approach is scarce.4, 5

As part of an effort to standardize postoperative protocols and feeding regimens after gastrostomy placement, we sought to determine whether this subset of patients had a similar risk profile after gastrostomy placement and should be included in a standardized pathway. The objective of this study was to evaluate the outcomes and early complications of children with VP shunts undergoing gastrostomy placement.

Section snippets

Materials and methods

After approval by the Institutional Review Board at Texas Children's Hospital (H-39576), medical records of children 18 y old or younger who underwent a laparoscopic gastrostomy tube placement between January 2014 and October 2016 were retrospectively reviewed. At our institution, almost all gastrostomies are carried out laparoscopically with the exception of children with congenital heart defects which require cardiovascular anesthesiologist and are carried out open. This cohort of patients

Patient characteristics

There were 270 children who underwent laparoscopic gastrostomy tube placement by 15 pediatric surgeons. Although there may be attending variation in care, there are no systematic differences in children in the intraoperative care of children with and without VP shunts. The median age was 2.7 y, and 50% were male. The median weight was 11.4 kg with a median BMI of 15.5. Based on the American Society of Anesthesiologists physical status classification (ASA), most (76%) patients were an ASA class

Discussion

We have previously shown significant variation in the postoperative care of children undergoing gastrostomy placement.6 Reducing variation through implementation of guidelines and treatment protocols is important for the improvement of clinical care and reduction in costs.7, 8, 9 Care pathways are the most widely researched intervention to reduce variability and have been shown to be effective in reducing variations.7, 8, 9 However, a systematic review by Howell et al. found that of 20 studies

Acknowledgment

Authors' contributions: Study design was contributed by E.H.R., Y.R.Y., J.G.N., and S.R.S. Data collection was performed by E.H.R., K.M., A.S.D., and A.K. Analysis was carried out by E.H.R. Drafting and editing of article was carried out by E.H.R., Y.R.Y., S.R.S., J.G.N., K.M., A.S.D., and A.K.

References (20)

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