Laparoscopic assisted ventriculoperitoneal shunt revisions as an option for pediatric patients with previous intraabdominal complications

Abstract

Multiple shunt failure is a challenge in pediatric neurosurgery practice and one of the most feared complications of hydrocephalus. Objective: To demonstrate that laparoscopic procedures for distal ventriculoperitoneal shunt failure may be an effective option for patients who underwent multiple revisions due to repetitive manipulation of the peritoneal cavity, abdominal pseudocyst, peritonitis or other situations leading to a "non reliable" peritoneum. Method: From March 2012 to February 2013, the authors reviewed retrospectively the charts of six patients born and followed up at our institution, which presented with previous intra-peritoneal complications and underwent ventriculoperitoneal shunt revision assisted by video laparoscopy. Results: After a mean follow-up period of nine months, all patients are well and no further shunt failure was identified so far. Conclusion: Laparoscopy assisted shunt revision in children may be, in selected cases, an effective option for patients with multiple peritoneal complications due to ventriculo-peritoneal shunting.Keywords: hydrocephalus, ventriculoperitoneal shunt, abdominal pseudocyst, laparoscopic surgery. RESUMOMúltiplas disfunções de derivações ventrículo-peritoneais em pacientes crônicos são complicações temidas no tratamento das hidrocefalias e um desafio na prática neurocirúrgica. Objetivo: Demonstrar que a abordagem laparoscópica para o tratamento das obstruções distais das derivações ventrículo-peritoneais é uma opção eficaz em pacientes submetidos a múltiplas revisões, manipulação repetitiva da cavidade abdominal, pseudocisto abdominal, peritonite ou outras complicações indutoras de peritônio "não confiável". Método: Os autores revisaram retrospectivamente, de março de 2012 a fevereiro de 2013, os prontuários de seis pacientes nascidos e acompanhados em um hospital pediátrico, que apresentaram múltiplas complicações intraperitoneais e tiveram a revisão de derivações ventrículo-peritoneais assistida por videolaparoscopia. Resultados: Todos os pacientes melhoraram clinicamente e nenhuma outra disfunção foi identificada após um período de acompanhamento médio de 9 meses. Conclusão: Revisão distal de derivações ventrículo-peritoneais assistida por videolaparoscopia em crianças é, em casos selecionados, uma opção eficaz para pacientes crônicos com história de múltiplas complicações peritoneais.Palavras-chave: hidrocefalia, derivação ventrículo-peritoneal, pseudocisto abdominal, cirurgia laparoscópica.Surgical treatment of hydrocephalus accounts for most of pediatric neurosurgical procedures and ventriculo-peritoneal shunting (VP shunt) remains the main option of treatment and also a major concern regarding complications 1,2,3 . Shunt complications, defined as obstruction, overdrainage, loculation or infection, sometimes demands difficult solutions with high surgical morbidity and mortality 1,2,3,4 .Abdominal complications of VP shunt are not rare and the main causes of distal catheter failure are related to extra peritoneal retraction of the catheter, incis...

Laparoscopy versus mini-laparotomy peritoneal catheter insertion of ventriculoperitoneal shunts: a systematic review and meta-analysis

“…Distal shunt failure is defined as any distal catheter-related problem that requires a return to surgery for management, such as shunt malfunction, displacement, misplacement, malposition, dislocation, and obstruction. It is reported in case series to occur in 0%-15.7% of laparoscopically inserted peritoneal catheters 1,5,6,9,13,20,35,37 and in 6%-28.7% of mini-laparotomy inserted catheters. 18,28 In this meta-analysis, the pooled data also show that the laparoscopic method significantly decreased the rate of distal shunt failure, which could be attributed to 2 main reasons, one being that the laparoscopic technique could prevent the distal shunt end from preperitoneal placement and confirm its efficacy simultaneously by direct vision.…”

A Retrospective Analysis of Ventriculoperitoneal Shunt Revision Cases of a Single Institute

“…Neuronavigation guidance provided longer shunt survival by accurate insertion of the proximal catheter, especially in patients with a small ventricle, such as slit ventricle syndrome, or benign intracranial hypertension 14 20) . Laparoscopic insertion of a peritoneal catheter was also proposed for distal catheter insertion or revision 4 21 22 27 33 35) . It is relatively difficult to introduce a peritoneal catheter in patients with a past history of abdominal surgery 4) .…”

“…Laparoscopic insertion of a peritoneal catheter was also proposed for distal catheter insertion or revision 4 21 22 27 33 35) . It is relatively difficult to introduce a peritoneal catheter in patients with a past history of abdominal surgery 4) . In our series, all the malposition cases were on the proximal side.…”

Abdominal Complications Related to Ventriculoperitoneal Shunt Placement: A Comprehensive Review of Literature

“…The peritoneal cavity is the main place to divert the CSF due to this high ability to absorb fluids. Therefore, loss of absorption capacity of peritoneal membrane is the main cause of VPS failure related to APC [14,29].…”

“…Abdominal pseudocysts and ascites usually present with abdominal pain and distension due to increased abdominal volume [34]. Other reported presentations include shunt dysfunction symptoms such as fever and abdominal complaints of abdominal tenderness and acute abdomen [29,[35][36][37]. Serious acute symptoms related to worsening hydrocephalus or central nervous system infection are also observed [38].…”