Elsevier

Journal of Pediatric Surgery

Volume 46, Issue 11, November 2011, Pages 2146-2150
Journal of Pediatric Surgery

Original article
The use of laparoscopy in ventriculoperitoneal shunt revisions

https://doi.org/10.1016/j.jpedsurg.2011.07.001Get rights and content

Abstract

Introduction

Ventriculoperitoneal shunts (VPSs) are routinely placed in children with hydrocephalus. However, they often encounter problems, and revisions are frequent. We sought to evaluate our institutional experience with laparoscopic-assisted VPS revisions.

Methods

With institutional review board approval, a retrospective chart review of 17 consecutive patients who underwent 19 laparoscopic-assisted VPS revisions was conducted. Data extracted included patient demographics, indications for laparoscopic-assisted revision, complications, and shunt outcomes.

Results

The median age at revision was 12 years (0.4-20 years). Ten children (58.8%) had 2 or more previous VPS revisions. Indications for laparoscopic revision included adhesive obstruction, broken shunt retrieval, cerebrospinal fluid pseudocyst, diagnostic laparoscopy, and conversion from ventriculoatrial shunt to VPS. Three patients required repeat VPS revision for distal shunt failure, whereas 2 patients required repeat VPS revision for proximal dysfunction. Failures occurred 5 to 258 days after laparoscopic-assisted revision. Median follow-up was 21 weeks (interquartile range, 6-57 weeks). No patients developed abdominal infections postoperatively.

Conclusion

Laparoscopy is useful in select patients with distal VPS failure. Patients with multiple previous revisions, prior abdominal surgery, previous intraperitoneal infections, broken devices, or cerebrospinal fluid pseudocysts may benefit from this approach. Further prospective studies with long-term follow-up are needed to determine which patients benefit most from the laparoscopic-assisted approach.

Section snippets

Methods

A retrospective chart review was conducted on 17 patients who underwent 19 consecutive laparoscopic-assisted VPS revisions at the Montreal Children's Hospital, a tertiary care pediatric institution, between January 2005 and December 2010. A comprehensive search of our institution's patient database revealed 184 patients who underwent VPS revision during the study period. Patients were identified using all applicable Canadian Classification of Intervention codes for VPS revision.

The operative

Results

The study population consisted of 5 men and 12 women with a median age at laparoscopic-assisted VPS revision of 12 years (range, 5 months to 20 years). The primary causes of hydrocephalus in our study were congenital neurologic abnormalities, intraventricular hemorrhage, and intracerebral tumors. Comorbidities are listed in Table 1. Forty-one percent of the study population had previous, non–VPS-related, abdominal surgery including congenital diaphragmatic hernia repair, bowel resection for

Discussion

Ventriculoperitoneal shunts are critical devices required for the management of hydrocephalus. Many of these devices have good durability, but malfunction can lead to life-threatening symptoms that mandate urgent revision or replacement of the shunt. Although the timing of malfunction is unpredictable, proximal dysfunction often occurs in the first 2 years of shunt life, whereas distal dysfunction predominates after 2 years [3]. Recently, the division of pediatric general surgery has been

References (12)

There are more references available in the full text version of this article.

Cited by (0)

View full text
Copyright © 2011 Elsevier Inc. All rights reserved.