E. Rosenfeld, MD1, K. Mazzolini, BS1, A. S. DeMello1, A. Karediya1, Y. Yu1, J. G. Nuchtern1, S. R. Shah1 1Baylor College Of Medicine & Texas Children’s Hospital,DeBakey Department Of Surgery,Houston, TX, USA
Introduction: In patients requiring gastrostomies, ventriculoperitoneal (VP) shunts are a frequently encountered comorbidity. The objective of this study is to evaluate the postoperative management of children with VP shunts that undergo laparoscopic gastrostomy placement, and determine their incidence of complications. We hypothesized that the presence of a VP shunt wound not increase the rate of immediate complications in children undergoing laparoscopic gastrostomy placement.
Methods: Children 18-years-old or younger who underwent laparoscopic gastrostomy placement at a freestanding academic children's hospital between 1/1/2014 and 9/30/2016 were reviewed. Data collected included demographics, postoperative feeding regimen, and clinical outcomes (including complications within 90 days of gastrostomy placement). We compared patients based on their presence of a VP shunt prior to laparoscopic gastrostomy. Statistical analysis was performed using Chi-square, Fisher's exact and Wilcoxon Rank-Sum tests.
Results: We reviewed the medical records of 270 children that underwent laparoscopic gastrostomy placement by 15 pediatric surgeons. Of these, 9% (25) had a previously placed VP shunt. In comparing patients with a VP shunt to those without a VP shunt there was no significant difference in median age (4 vs 3 years, p=0.92), gender (48% vs 51% males, p=0.80), body mass index (15 vs 16, p=0.69), or preoperative diet (48% vs 47% nasogastric tube dependent, p=0.60). In addition, there was no significant difference in intraoperative or postoperative management in those with or without a VP shunt: procedure time (43 vs 42 minutes, p=0.37), type of gastrostomy placed (96% vs 97% MIC-KEY button, p=0.37), postoperative gastrostomy contrast study (9% vs 7%, p=0.68), day of initiation of postoperative feeds (84% vs 73% on postoperative day #1, p=0.70), method of initiation of feeds (60% vs 55% continuous, p=0.25), and type of initial feeds (83% vs 71% Pedialyte, p=0.24). Similarly, there was no significant difference in clinical outcomes between the two cohorts, including hospital length of stay, return to the emergency department, or postoperative complications within 90 days (Table 1).
Conclusion: Children with ventriculoperitoneal shunts do not have a higher rate of immediate complications after laparoscopic gastrostomy placement, and may be managed similar to other children in the postoperative period.
