Laparoscopy Is Useful for Successful Distal Ventriculoperitoneal Shunt Placement in Children with Previous Abdominal Surgery

Abstract

Introduction:

Laparoscopy is being used for assistance in ventriculoperitoneal (VP) shunt placement. We have found it especially useful to guide distal catheter placement in children who have had multiple VP shunt revisions and previous abdominal surgery. We therefore reviewed our experience utilizing laparoscopy for VP shunt placement over the past year.

Methods:

We conducted a retrospective review of all children undergoing laparoscopy for VP shunt who have had previous abdominal surgery.

Results:

Nine children underwent 11 laparoscopic procedures for VP shunt placement. All children had undergone multiple abdominal procedures, and all had previously undergone open VP shunt placement. The mean age of all children undergoing laparoscopy was 11.4 years. Shunt infection (in 6 children) and shunt malfunction (in 5 children) were the reasons for VP shunt revision. A single 3-mm port was used in 9 of 11 procedures. All children had adhesions visualized, 2 required adhesiolysis, and in one VP shunt was not possible. The mean operative time was 90.6 minutes. There were no complications directly related to laparoscopy. Postoperative length of stay was 3.5 days. Four patients have not needed another revision (mean, 243 days), while 4 patients (6 cases) have needed subsequent revision (mean, 32 days).

Conclusion:

Laparoscopy can be safely performed in children requiring VP shunt revision who have undergone previous abdominal surgery. It facilitates successful minimally invasive placement of VP shunts in these children, who otherwise would require a more extensive procedure.