Infections of pediatric cerebrospinal fluid shunts related to fundoplication and gastrostomy.
OBJECTIVE
There is conflicting information in the literature regarding the increased risk of ventriculoperitoneal (VP) shunt infection after abdominal surgical procedures such as gastrostomy tube (GT) placement and Nissen fundoplication (NF) in the young patient. To further elucidate this potential association, the authors reviewed their institutional experience with such cases.


METHODS
The authors retrospectively reviewed the records of all patients with shunted hydrocephalus who also underwent NF procedures and/or GT placements over a 9-year period.


RESULTS
During this 9-year period, 3065 cerebrospinal fluid (CSF) shunts were placed and 1630 NF procedures/GT placements were performed. Ninety-six patients were identified who received both a CSF shunt and NF procedures/GT placements. Seventy-nine patients had a functioning VP shunt (without recent [< 6 months] CSF infection or shunt revision) at the time of their abdominal procedure (NF procedure or GT placement). Of this latter cohort, there were 38 males and 41 females with a mean age of 6.4 months; 12.7% of these patients developed a shunt infection and 60% of these infections were due to Staphylococcus species.


CONCLUSIONS
Based on this study, an NF procedure/GT placement in a child with a VP shunt appears to carry approximately the same risk of shunt infection as a shunt placement operation. Moreover, the microbiology observed in these patients with infection did not differ significantly from the usual microorganisms responsible for VP shunt infections in infants/neonates. Finally, but not conclusively, an open NF procedure/GT placement may carry a higher infection risk than a laparoscopic-assisted NF procedure/GT placement.
Bui
Cuong J
CJ
Section of Pediatric Neurosurgery, University of Alabama at Birmingham and Children's Hospital, Birmingham, Alabama 35233, USA.
Tubbs
R Shane
RS
Pate
Gigi
G
Morgan
Traci
T
Barnhart
Douglas C
DC
Acakpo-Satchivi
Leslie
L
Wellons
John C
JC
Oakes
W Jerry
WJ
Blount
Jeffrey P
JP
D015331:Cohort Studies; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D018662:Fundoplication / Q000009:adverse effects*; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*