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Laparoscopic fundoplication in children with ventriculo-peritoneal shunts
Rainer Kubiak1, Clare Skerritt, Hugh W Grant
1Department of Paediatric Surgery, Oxford University Hospital , Headington, Oxford, United Kingdom. rainerkubiak@hotmail.com
Insights
Laparoscopic fundoplication is a safe procedure for children with ventriculo-peritoneal shunts, showing low complication rates. Careful consideration of adhesions and gastrostomy placement is recommended for optimal outcomes in these pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neurosurgery
Background:
- Children with ventriculo-peritoneal (V-P) shunts face risks of infection, morbidity, and mortality.
- Some pediatric patients with V-P shunts require additional abdominal surgeries like fundoplication.
- Assessing outcomes of laparoscopic fundoplication in children with existing V-P shunts is crucial.
Purpose of the Study:
- To evaluate the feasibility and outcomes of laparoscopic fundoplication in children with V-P shunts.
- To compare complication rates and surgical outcomes between children with and without V-P shunts undergoing fundoplication.
Main Methods:
- Retrospective review of a prospectively maintained database (July 1998 - March 2011).
- Analysis of intra- and postoperative complications, including shunt-related issues within 6 months.
- Comparison of V-P shunt patients with a control group using statistical tests (t-test, chi-squared, Fisher's exact).
Main Results:
- 11 out of 343 children (3.2%) had a V-P shunt during fundoplication.
- 55% of V-P shunt patients had adhesions; only 1 conversion to open surgery was needed.
- No postoperative shunt dysfunction or infection occurred; outcomes were similar to non-shunt patients.
Conclusions:
- Laparoscopic fundoplication is a feasible surgical option for children with V-P shunts.
- While adhesions are common, conversion rates are low, indicating safety.
- Simultaneous percutaneous endoscopic gastrostomy (PEG) insertion requires careful laparoscopic guidance to mitigate complications.
Background:
Children with ventriculo-peritoneal (V-P) shunts have a significant risk of morbidity and mortality from infections. Many of these patients have other co-morbidities and may require subsequent abdominal surgery, including fundoplication with or without gastrostomy placement. The aim of our study was to assess the outcomes of laparoscopic fundoplication in children with a V-P shunt in situ.
Subjects And Methods:
A retrospective review of a prospectively maintained database on children who underwent laparoscopic fundoplication with a V-P shunt in situ at the time of surgery between July 1998 and March 2011 was conducted. Primary outcomes included intra- and postoperative complications as well as shunt-related problems within a 6-month period after surgery. The subset of children with V-P shunts was compared with those who underwent fundoplication without shunts. Variables were compared using the two-tailed Student's t test, chi-squared test, or Fisher's exact test. Significance was defined as P≤.05.
Results:
Out of a total of 343 children who underwent fundoplication, 11 (6 girls, 5 boys) had a V-P shunt in situ at the time of surgery (3.2%). The median age at laparoscopy was 2.2 years (range, 0.7-13.8 years). Weight at surgery ranged from 5.8 to 39.0 kg (median, 12.0 kg). The operating time (without gastrostomy placement) was 105 minutes (range, 80-140 minutes). In 6 patients (55%) moderate to severe adhesions were documented, but only 1 child required conversion to open surgery because of bleeding from the omentum. In a second patient the colon was perforated during insertion of the percutaneous endoscopic gastrostomy (PEG) and repaired laparoscopically. There was no postoperative shunt dysfunction or infection related to the laparoscopic procedure. There was no significant difference between V-P shunt patients and the main cohort regarding operating time, conversion to open surgery, need for admission to a high-care unit, opiate requirements, time to full feeds, and length of hospital stay.
Conclusions:
These data suggest that laparoscopic fundoplication is feasible in children with previous V-P shunt placement. Although there were considerable adhesions in approximately half of these patients, the rate for conversion to open surgery was low. Complications associated with simultaneous PEG insertion occur and should be anticipated by placing the gastrostomy under laparoscopic guidance.
