title: Diagnostic laparoscopy for intraabdominal evaluation and ventriculoperitoneal shunt placement in children: a means to avoid ventriculoatrial shunting.
abstract: BACKGROUND
  Laparoscopic assistance for the placement of a ventriculoperitoneal shunt (VPS) has been shown to be a safe, effective, and minimally invasive approach for distal peritoneal shunt placement. The purpose of our study was to review our experience with laparoscopy for VPS placement in patients with a potential hostile abdomen.
  
  
  METHODS
  After institutional review board approval, a retrospective analysis of all patients who underwent diagnostic laparoscopy for VPS placement from March 2009 to March 2013 was performed. Patient demographics and outcomes were analyzed.
  
  
  RESULTS
  Twenty-seven patients underwent diagnostic laparoscopy for VPS placement at a mean age of 7.7 ± 6.8 years. Twenty-five patients had previous shunts placed in the peritoneum, whereas 2 underwent initial placement. Sixteen patients (59%) had undergone previous non-shunt abdominal operations. Twenty-three patients (85%) had successful peritoneal shunt placement. Distal peritoneal shunt placement was unsuccessful at the time of laparoscopy in 4 patients (15%) secondary to adhesions. Of the 23 patients who had successful peritoneal shunt placement, 57% did not require further shunt intervention, 22% underwent conversion to a ventriculoatrial shunt, 17% underwent re-externalization, and 4% required distal shunt revision. Of the 4 patients who required externalization, 3 underwent a second laparoscopic procedure with successful peritoneal shunt placement.
  
  
  CONCLUSIONS
  Diagnostic laparoscopy eliminated the need for ventriculoatrial shunt placement in 85% of patients with a potentially hostile abdomen. Sixty percent required no further shunt revision. Laparoscopic-assisted peritoneal shunt insertion is a safe, minimally invasive technique in children with the added benefit of allowing full exploration and adhesiolysis.
authors.affiliation: Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine , St. Petersburg, Florida.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Farach
authors.forename: Paul D
authors.initials: PD
authors.lastname: Danielson
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Chandler
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004210:Dissection; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male; D010537:Peritoneum / Q000601:surgery*; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*