Laparoscopic-Assisted Placement of Ventriculo-Peritoneal Shunt Tips in Children with Multiple Previous Open Abdominal Ventriculo-Peritoneal Shunt Surgeries

Abstract

Background: Placing a ventriculo-peritoneal shunt in children with hydrocephalus is the standard of care. Many of these children will require revision of this portion of the shunt for a variety of reasons. Previously, it was thought that in a child with multiple previous ventriculo-peritoneal shunt (VPS) revisions, laparoscopy was contraindicated. This study aims to show that laparoscopy can be used safely and effectively in children with multiple previous ventriculo-peritoneal shunt surgeries. Materials and Methods: Laparoscopically assisted placement of the peritoneal portion of the ventriculo-peritoneal shunt in children with multiple previous VPS revisions was performed in 8 consecutive children (4 female) with ages ranging from 7 months to 18 years between May 2003 and September 2007. All eight children had undergone more than two previous VPS operations. All shunts were placed in areas free of adhesions and flow was observed under direct visualization. Results: All of the procedures were successful; none needed conversion to the standard mini-laparotomy approach. No obvious or occult injury to the abdominal components was noted during hospitalization or during follow-up. Six of 8 patients required lysis of adhesions at the time of the revision. Average length of hospital stay was 2.6 days and no revisions of the abdominal portion of the VPS have been required by any of the 8 patients after laparoscopic revision. Previously unknown complications of shunt surgery were corrected in 1 of 8 children. Conclusions: Laparoscopic placement of the peritoneal portion of a ventriculo-peritoneal shunt can be done safely and effectively in children with multiple previous VPS revisions due to improved visualization and placement of the shunt tip in a virgin area of the abdomen. Additionally, any known or unknown complications from previous VPS surgeries can be corrected with the laparoscopic approach. When combined with the reduction in pain, shorter hospital stay, and fewer immediate and future complications, this is the procedure of choice for patients requiring revision VPS surgeries in our hospital.

Key words

VP shunt - hydrocephalus - laparoscopy - minimally invasive - meningomyelocele

References

• 1 Sainte-Rose C, Piatt J H, Renier D. Mechanical complications in shunts.  Pediatr Neurosurg. 1991;  17 2-9
• 2 Delarue A, Guys J M, Lois-Borrione C. et al . Pediatric endoscopic surgery: pride and prejudice.  Eur J Pediatr Surg. 1994;  4 323-326
• 3 Esposito C, Porreca A, Gangemi M. et al . The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo-peritoneal shunts in children.  Pediatric Surg Int. 1998;  13 352-354
• 4 Jea A, Al-Otibi M, Bonnard A. et al . Laparoscopy-assisted ventriculoperitoneal shunt surgery in children: a series of 11 cases.  J Neurosurg. 2007;  106 421-425
• 5 Metzelder M L, Jesch N, Dick A. et al . Impact of prior surgery on the feasibility of laparoscopic surgery for children: a prospective study.  Surg Endosc. 2006;  20 1733-1737
• 6 Morgan Jr W W. The use of peritoneoscopy in the diagnosis and treatment of complications of ventriculo-peritoneal shunts in children.  J Pediatr Surg. 1979;  14 180-181
• 7 Oh A, Wildbrett P, Golub R. et al . Laparoscopic repositioning of a ventriculo-peritoneal catheter tip for a sterile abdominal cerebrospinal fluid (CSF) pseudocyst.  Surg Endosc. 2001;  15 518
• 8 Roitberg B Z, Tomita T, McLone D G. Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunt in children.  Pediatr Neurosurg. 1998;  29 267-273
• 9 Roth J, Sagie B, Szold A. et al . Laparoscopic versus non-laparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis.  Surg Neurol. 2007;  68 177-184
• 10 Schulohof L A, Worth R M, Kalsbeck J E. Bowel perforation due to peritoneal shunt: a report of seven cases and a review of the literature.  Surg Neurol. 1975;  3 265-269
• 11 Wakai S. Extrusion of peritoneal catheter through the abdominal wall in an infant.  J Neurosurg. 1982;  57 148-149
• 12 Wu J M, Lin H F, Chen K H. et al . Impact of previous abdominal surgery on laparoscopic appendectomy for acute appendicitis.  Surg Endosc. 2007;  21 570-573
• 13 Yu S, Bensard D D, Patrick D A. et al . Laparoscopic guidance or revision of ventriculoperitoneal shunts in children.  JSLS. 2006;  10 122-125