Immediate and long-term outcome analysis of lipomeningomyelocele repair in asymptomatic infants in a tertiary care center.
OBJECTIVE
To analyze immediate and long-term results of lipomeningomyelocele (LMM) repair in asymptomatic patients.


METHODS
Seventeen patients of LMM presented to Department of Paediatric Surgery over a period from 2011 to 2015 were evaluated preoperatively by magnetic resonance imaging of whole spine, and pre- and post-operative Ultrasound of kidney, ureter, bladder, and neurosonogram. Surgical procedure involved total excision of lipoma in 15 patients and near total excision in 2 patients. Division of filum terminale could be done in 15 out of 17 patients. Follow-up varied from 1 to 3.5 years (mean 1.9 years).


RESULTS
This study included 10 (58.8%) patients of lumbosacral LMM, 5 (29.4%) patients of sacral, and 2 (11.7%) patients of thoracolumbar LMM. About 13 (76.4%) patients were operated before 3 months of age, 2 (23.5%) patients were operated between 3 and 6 months, and two patients were operated between 6 and 11 months. None of the patients had bladder/bowel dysfunction preoperatively. Preoperative lower limb power was normal in all patients. Objective improvement in lower limb motor function was observed in 3 (17.6%) patients and three patients had decreased lower limb power. Two patients developed altered sensations and weakness of lower limb about 2.5-3 years after initial LMM repair. They needed repeat detethering of cord. Two patients had fecal pseudoincontinence, whereas one patient developed constipation. Bowel dysfunction was managed by rectal washouts, and oral laxatives were added if required. One (5.8%) patient of lumbosacral LMM and 1 (5.8%) patient of sacral LMM had urinary incontinence postoperatively. This was managed by clean intermittent catheterization with continuous overnight drainage. Conservative management of bladder and bowel dysfunction was effective in all patients till the last follow-up. Two patients developed hydrocephalus after LMM repair for which low-pressure ventriculoperitoneal shunt was inserted. Wound infection occurred in 1 (5.8%) patient, whereas 7 (41.1%) patients developed seroma in wound which responded to repeated aspirations under aseptic precautions.


CONCLUSIONS
With total excision of lipoma and division of filum terminale satisfactory outcome for asymptomatic patients of LMM can be achieved. Authors recommend early surgery for LMM even in asymptomatic patients. Patients with residual lipoma and undivided filum terminale should be observed closely for the development of progressive neurological changes.
Department of Paediatric Surgery, L.T.M.G. Hospital, Sion, Mumbai, Maharashtra, India.
Prashant Sadashiv
PS
Patil
Department of Paediatric Surgery, L.T.M.G. Hospital, Sion, Mumbai, Maharashtra, India.
Abhaya
A
Gupta
Department of Paediatric Surgery, L.T.M.G. Hospital, Sion, Mumbai, Maharashtra, India.
Paras L
PL
Kothari
Department of Paediatric Surgery, L.T.M.G. Hospital, Sion, Mumbai, Maharashtra, India.
Geeta
G
Kekre
Department of Paediatric Surgery, L.T.M.G. Hospital, Sion, Mumbai, Maharashtra, India.
Rahul
R
Gupta
Department of Paediatric Surgery, L.T.M.G. Hospital, Sion, Mumbai, Maharashtra, India.
Vishesh
V
Dikshit
Department of Paediatric Surgery, L.T.M.G. Hospital, Sion, Mumbai, Maharashtra, India.
Kedar
K
Mudkhedkar
Department of Paediatric Surgery, L.T.M.G. Hospital, Sion, Mumbai, Maharashtra, India.
Krishna
K
Kesan
Hydrocephalus; lipomeningomyelocele; tethered cord; ventriculoperitoneal shunt