title: The use of laparoscopy in ventriculoperitoneal shunt revisions.
abstract: BACKGROUND
  Ventriculoperitoneal shunts (VPSs) are routinely placed in children with hydrocephalus. However, they often encounter problems, and revisions are frequent. We sought to evaluate our institutional experience with laparoscopic-assisted VPS revisions.
  
  
  METHODS
  With institutional review board approval, a retrospective chart review of 17 consecutive patients who underwent 19 laparoscopic-assisted VPS revisions was conducted. Data extracted included patient demographics, indications for laparoscopic-assisted revision, complications, and shunt outcomes.
  
  
  RESULTS
  The median age at revision was 12 years (0.4-20 years). Ten children (58.8%) had 2 or more previous VPS revisions. Indications for laparoscopic revision included adhesive obstruction, broken shunt retrieval, cerebrospinal fluid pseudocyst, diagnostic laparoscopy, and conversion from ventriculoatrial shunt to VPS. Three patients required repeat VPS revision for distal shunt failure, whereas 2 patients required repeat VPS revision for proximal dysfunction. Failures occurred 5 to 258 days after laparoscopic-assisted revision. Median follow-up was 21 weeks (interquartile range, 6-57 weeks). No patients developed abdominal infections postoperatively.
  
  
  CONCLUSIONS
  Laparoscopy is useful in select patients with distal VPS failure. Patients with multiple previous revisions, prior abdominal surgery, previous intraperitoneal infections, broken devices, or cerebrospinal fluid pseudocysts may benefit from this approach. Further prospective studies with long-term follow-up are needed to determine which patients benefit most from the laparoscopic-assisted approach.
authors.affiliation: The Division of Pediatric General Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada H3H 1P3. kmartin2008@meds.uwo.ca
authors.forename: Kathryn
authors.initials: K
authors.lastname: Martin
authors.forename: Robert
authors.initials: R
authors.lastname: Baird
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Farmer
authors.forename: Sherif
authors.initials: S
authors.lastname: Emil
authors.forename: Jean-Martin
authors.initials: JM
authors.lastname: Laberge
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shaw
authors.forename: Pramod
authors.initials: P
authors.lastname: Puligandla
mesh_terms: D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004868:Equipment Failure; D005260:Female; D006325:Heart Atria; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt