Laparoscopic retrieval of disconnected shunt catheters from the peritoneal cavity as a day-case procedure in children--early feasibility report.

OBJECTIVE

The aim of this study was to report our experience with laparoscopic retrieval of disconnected shunt catheters in children.

METHODS

Demographic data, indications for shunt insertion, time to disconnection, symptomatology, time to retrieval, operative details, length of stay and complications were recorded retrospectively. Laparoscopy was performed using two 5-mm ports and 10-12-mmHg CO(2) pneumoperitoneum.

RESULTS

Seven children (five boys, two girls) had laparoscopic retrieval of disconnected ventriculoperitoneal (VP; n = 6) and lumboperitoneal (n = 1) shunt catheters between 2006 and 2008. Median age was 8 (5-15) years. The indications for shunt insertion were hydrocephalus (n = 4), traumatic subdural haematoma (n = 1), pinealoblastoma (n = 1) and idiopathic intracranial hypertension (n = 1). Median interval from insertion to disconnection was 3 (range 1-10) years. Presenting symptoms were headache (n = 3) and neck swelling (n = 1). Three children were asymptomatic. Median referral-to-procedure time was 69 (range 2-224) days. One child underwent emergency removal of disconnected shunt with laparoscopic-assisted VP shunt insertion under the same anaesthetic. One child had a laparotomy as the catheter tip had penetrated the sigmoid mesocolon close to the bowel and could not be safely removed laparoscopically. Of the remaining five children, four had the procedure performed as day cases. There was no intra- or post-operative morbidity or subsequent shunt infections.

CONCLUSIONS

Peritoneally migrated shunt catheters have a risk of viscus injury, particularly bowel perforation. In our experience, laparoscopic retrieval of migrated shunt catheters was safe both as an emergency procedure and electively, when it was performed as a day-case basis in selected patients with excellent outcome.