Laparoscopically Assisted Shunt Surgery for Children with Hydrocephalus

Abstract

ABSTRACT

Background and Purpose:

Over the lifetime of their ventriculoperitoneal shunts, many children with hydrocephalus require frequent abdominal procedures for shunt revision or replacement. The natural history is one of progressive difficulty in maintaining subsequent functional catheters. Recently, we have utilized laparoscopy in the management of this special population of children. We present our initial experience with laparoscopically assisted shunt surgery (LASS), assessing surgical outcome.

Patients and Methods:

The charts of nine boys and seven girls who underwent LASS at our institution between May 1997 and September 1999 were reviewed. The mean number of abdominal shunt operations prior to LASS was 3.0 (range 2–9) per child. The mean number of trocar sites (2 or 5 mm) for LASS was 2.0 (range 1–3). The mean follow-up was 18.5 months (range 10–38 months).

Results:

All 16 cases were completed laparoscopically with a mean operative time of 48.2 minutes (range 25–112 minutes). Ten patients had distal shunt revision, and six had shunt replacement. Six patients also had retained shunt fragments retrieved by LASS. Pseudocysts were effectively drained endoscopically in pertinent cases. There were no shunt infections during the postoperative period (first 30 days). Six patients (38%) had subsequent shunt revision or replacement, with one patient requiring shunt replacement during the postoperative period.

Conclusions:

Laparoscopically assisted shunt surgery can be performed successfully in children with hydrocephalus and is well suited for those requiring shunt revision or replacement. A randomized controlled study is needed to truly assess the impact of LASS on improving the lifespan of ventriculoperitoneal shunts.