Laparoscopic management of pediatric and adolescent patients with intra-abdominal complications of ventriculoperitoneal shunt

Abstract

Background/purpose: Ventriculoperitoneal (VP) shunt is the most common operative procedure performed in the treatment of hydrocephalus. The aim of this procedure is to drain CSF from the ventricles to the peritoneal cavity, thus to decrease the intracranial pressure. Numerous complications as a result of this technique are reported in the literature and are most commonly located around the peritoneal end of the shunt tube. The standard approach for management is laparotomy and correction of the complication. This approach, although solves the problem, causes the formation of adhesions, which are also not devoid of consequences. The aim of this study is to present our experience and outline the role of laparoscopy in the management of intraabdominal complications of VP shunt in pediatric and adolescent patients.

Patients and Methods: Over a period of 4 years, 14 patients were managed and recruited in this study. All patients were presented with recurrent abdominal signs and symptoms or elevated intracranial pressure. All patients were managed laparoscopically according to the final diagnosis.

Results: Fourteen patients (9 men and 5 women) with abdominal complications of VP shunt catheter were managed. Their ages at operation were ranged from 10 months to 15 years. All patients were investigated, diagnosed and managed laporoscopically. The median operative time of the laparoscopic procedure varied according to the diagnosis. It was 120 minutes in pseudocysts, 45 minutes in recurrent congenital inguinal hernias, 100 minutes in adhesive intestinal obstruction and 35 minutes in subcutaneous cyst and 30 minutes in umbilical fistula. Follow up period extended for 24 months after the procedure and all patients had complete resolution of their presenting abdominal or neurological symptoms. The length of the postoperative hospital stay ranged from one day in recurrent congenital hernias up to 4 days in the other procedures. There were no intra- or postoperative complications related to the laparoscopic technique.

Conclusion: Laparoscopic is a very useful diagnostic and therapeutic tool in dealing with intra-abdominal complications of VP shunt with high safety and an excellent outcome.

Keywords: hydrocephalus, laparoscopic management, ventriculoperitoneal shunt