The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo-peritoneal shunts in children

Abstract

Ventriculo-peritoneal shunts (VPS) are the most frequent operative procedures used to treat hydrocephalic children. Abdominal complications of VPS are now a rare event; however, their frequency varies from 5% to 47% according to reports. Anything that causes an obstruction or impediment of the VP derivation system will lead to intracranial hypertension, which requires immediate surgery. From 1985 to 1995 at the Division of Pediatric Surgery of the Federico II University of Naples, ten laparoscopies were performed in ten children with VPS complications. Cerebrospinal fluid pseudocysts were found in four infants. There was one case of abdominal wall perforation by the tip of the catheter at the umbilical level, two bowel obstructions, and one catheter was lost in the abdominal cavity. Finally, two children had malfunctioning of the peritoneal limb of the catheter. The laparoscopic technique was curative in all ten cases, thus avoiding a conventional laparotomy and the consequent risk of adhesions, which could cause further complications.

Laparoscopic management of distal ventriculoperitoneal shunt complications

“…According to the literature, the percentage of abdominal complications related to VP shunts ranges from 5% to 47% [7,8]. The most common distal VP shunt complications include subcutaneous collection of cerebrospinal fluid (CSF), peritoneal pseudocyst formation, extraperitoneal retraction of the catheter, and the development of incisional hernia [8][9][10].…”

Placement of the Peritoneal End of a Ventriculoperitoneal Shunt in the Suprahepatic Space: Does It Improve Prognosis?

“…The various reported abdominal complications of the lower end are ascitis and pseudocyst formation [7], visceral perforation [8], inguinoscrotal migration [9], transanal migration [10], intestinal obstruction, abdominal wall and bladder perforation [11, 12], as well as umbilical granuloma with spontaneous drainage of CSF [13]. Most of these complications are due to placement of the lower end in the general peritoneal cavity where it lies free, and thus, is able to migrate to any site.…”

“…The most accepted treatment of hydrocephalus is surgical, in which CSF is diverted from the ventricles by shunt systems of various types [2]. Ventriculoperitoneal shunts (VPS) are the most frequent operative procedures used to treat hydrocephalic children [3]. The ventricular end is placed in the lateral ventricle.…”

Laparoscopic management of CSF pseudocyst abdomen

“…[7] Esposito et al recommended that laparoscopy is very safe in patients with abdominal complications of ventriculoperitoneal shunts especially in adhesions and pseudocyst formation. [8] To summarize, ventriculoperitoneal shunts that malfunction secondary to intra-abdominal processes (adhesions, pseudocyst) are readily salvaged using the laparoscopic technique, thus avoiding the attendant complications of open laparotomy.…”