Abdominal Complications Following Ventriculoperitoneal Shunt Surgery in Pediatric Patients

Introduction: The traditional management of hydrocephalus still is the placement of ventriculoperitoneal shunts. The majority of pediatric patients require one or more revisions over their lifetime. Revisions may be required for infections, proximal site malfunction, or distal catheter complications. The authors present their experience with distal catheter complications managed by open surgery and laparoscopically in pediatric patients. Aim: The aim of this study is the evaluation of abdominal complications following ventriculoperitoneal shunt. Material and Methods: We report a retrospective study including pediatric patients with abdominal complications secondary to ventriculopertoneal shunt for hydrocephalus. Results: Sixty two pediatric patients, aged from 1 month to 17 years, were treated for hydrocephalus in period from 2009 to 2014. Fivty seven ventriculoperitoneal shunt procedures were performed. This study retrospectively evaluated 13 patients regarding complications relating to the peritoneal end of the catheter. There were 21 complications requiring surgical revisions. Common complications consisted of mechanical shunt malfunction 4, catheter tip occlusion 7, shunt infection 5, abdominal cerebrospinal fluid loculations and pseudocysts formation 2, intestinal adhaesiones 4, abdominal wall wound infection 2. Operative procedures included laparoscopic exploration wih peritoneal shunt deliberation 8,, reimplantation of the whole shunt 7, exernal drainage 4 and revisio of abdominal wound in two patients. Conclusion: Distal ventriculoperitoneal shunt complications can be safely managed laparoscopically. This approach allows the intraabdominal portion of the catheter to be assessed and problems to be managed, thereby salvaging the existing shunt and avoiding the potential morbidity associated with additional ventriculoperitoneal shunt placement.