The safety of laparoscopy in pediatric patients with ventriculoperitoneal shunts.
BACKGROUND
In pediatric patients requiring abdominal operations, ventriculoperitoneal (VP) shunts for hydrocephalus are a frequently encountered comorbidity. Laparoscopy has not been extensively evaluated in this population, and there are concerns about the safety of insufflation under pressure with the shunt in place. There are a paucity of data in the literature to address this issue. Further, there is a relative lack of long-term follow-up in the literature to document shunt function over time after abdominal procedures. Therefore, we reviewed our experience in patients with VP shunts who underwent either open or laparoscopic abdominal procedures to determine the safety of laparoscopy in these patients.


METHODS
We conducted a retrospective review of all pediatric patients with VP shunts who underwent laparoscopic and/or open abdominal operations at a single institution from 1998 to 2008. Complications were defined as a shunt- or surgery-related event (including any shunt revisions) within 6 months of abdominal surgery. Continuous variables were compared by using an independent sampled, two-tailed Student's t-test. Discrete variables were analyzed with Fisher's exact test with Yates correction, where appropriate. Significance was defined as P < or = 0.05.


RESULTS
A total of 99 intra-abdominal operations were performed on patients with VP shunts: 51 were laparoscopic and 48 were open. Mean age was 3.17 versus 2.93 years, respectively (P = 0.77). The most common procedure performed in both groups was fundoplication with gastrostomy. There were no episodes of air embolism into the shunt. There was 1 shunt infection in the laparoscopic group and 3 in the open group (P = 0.56).


CONCLUSIONS
Our data suggest that laparoscopy is safe in patients with ventriculoperitoneal shunts.
Fraser
Jason D
JD
Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri, USA.
Aguayo
Pablo
P
Sharp
Susan W
SW
Holcomb III
George W
GW
Ostlie
Daniel J
DJ
St Peter
Shawn D
SD
D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D013505:Digestive System Surgical Procedures; D018662:Fundoplication; D005774:Gastrostomy; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000601:surgery; D010535:Laparoscopy; D011028:Pneumoperitoneum, Artificial; D012086:Reoperation; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt