Abstract
Objective
In spite of the recent interest in endoscopic third ventriculostomy, ventriculoperitoneal (VP) shunt is still the gold standard in treating non-obstructive hydrocephalus in children. The peritoneal cavity remains the optimal site for cerebrospinal fluid (CSF) diversion. Shunt insertion and re-interventions carry a high risk of inaesthetic abdominal scars and long-term morbidity. We report a technique of transumbilical shunt insertion, which provides better cosmetic results and without many more complications. This approach has been performed for a long period in a wide variety of intra-abdominal conditions by pediatric surgeons.
Methods
Between March and October 2003, we inserted 12 VP shunts in children. For eight consecutively treated children the follow-up is more than 3 months. All the shunts were inserted through the umbilicus. These eight children are the subjects of this study. Indications for shunting were: communicating hydrocephalus (6 cases), subdural hematoma (1 case), and hygroma associated with an arachnoid cyst (1 case). The population consisted of 7 boys and 1 girl, ranging in age between 6 weeks and 47 months (mean age: 15 months), and their body weights varied between 2,110 g and 18,000 g (mean weight: 8,470 g). All children were examined twice a day for 3 days, and wounds were examined daily to check for the absence of sepsis or dehiscence. Clinical controls were performed 1 month after discharge. The operating surgeon was invited to comment on any difficulties encountered in making or closing this incision afterwards.
Results
The average length of clinical follow-up was 6 months (range 4–7 months). One infection of the VP shunt occurred. It was treated with external drainage and antibiotics. After 1 week, a second VP shunt was inserted using the same technique without particular difficulty and with a nice cosmetic result. Concerning the seven other children, the cosmetic results were optimal, with no puckered abdominal scars or wound dehiscence, and with no perioperative or long-term complications related to the umbilical approach.
Conclusion
At this early follow-up, umbilical incision for shunt insertion is a safe and easy technique. It provides an optimal cosmetic result, even in cases of re-intervention. This minimally invasive surgery does not require long specialized training. We have not shown an increase in complications associated with a “learning curve.” Longer follow-up is needed to evaluate the risk of infection.
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References
Begin GF (1993) Appendectomy in children by simple port laparoscopy [in French]. Chir Endosc 2:6–9
Begin GF (1993) Creation du pneumoperitoine sous contrôle visuel. J Coelio Chir 5:18–20
Buanes T, Mjaland O (1996) Complications in laparoscopic and open cholecystectomy: a prospective comparative trial. Surg Laparosc Endosc 6:266–272
Caleel RT (2000) Trans-umbilical endoscopic breast augmentation: submammary and subpectoral. Plast Reconstr Surg 106:1177–1182
Choi S, McComb JG, Levy ML, Gonzalez-Gomez I, Baysrton R (2003) Use of elemental iodine for shunt infection prophylaxis. Neurosurgery 52:908–912
Drake JM, Iantosca MR (2001) Management of pediatric hydrocephalus with shunts. In: McLone DG (ed) Pediatric neurosurgery. Surgery of the developing nervous system, 4th edn. Saunders, Philadelphia, pp 505–522
Georgeson KE, Owings E (2000) Advances in minimally invasive surgery in children. Am J Surg 180:362–364
McGirt MJ, Zaas A, Fuchs HE, George TM, Kaye K, Sexton DJ (2003) Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis 36:858–862
Paes TRF, Stoker DL, Morecroft Ng, Morecroft J (1987) Circumumbilical versus trans-umbilical abdominal incision. Br J Surg 74:822–823
Plattner V, Raffaitin P, Mirallie E, Legus C, Heloury Y (1997) Appendicites compliquées de l’enfant: laparoscopie ou MacBurney? Ann Chir Paris 51:990–994
Poli-Merol ML, François S, Lefevre F, Bouche Pillon-Persyn MA, Lefort G, Daoud S (1996) Interest of umbilical fold incision for pyloromyotomy. Eur J Pediatr Surg 6:13–14
Soutter AD, Askew AA (2003) Trans-umbilical laparotomy in infants: a novel approach for a wide variety of surgical disease. J Pediatr Surg 38:950–952
Tan KC, Bianchi A (1986) Circumumbilical incision for pyloromyotomy. Br J Surg 73:339
Valla JS, Ordorica-Flores RM, Steyart H, Merrot T, Bartels AM, Breaud J, Ginier C, Cheli M (1999) Umbilical one-puncture laparoscopic-assisted appendectomy in children. Surg Endosc 13:83–85
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Scavarda, D., Breaud, J., Khalil, M. et al. Transumbilical approach for shunt insertion in the pediatric population: an improvement in cosmetic results. Childs Nerv Syst 21, 39–43 (2005). https://doi.org/10.1007/s00381-004-1028-x
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DOI: https://doi.org/10.1007/s00381-004-1028-x