Risk of Ventriculoperitoneal Shunt Infections After Laparoscopic Placement of Chait Trapdoor™ Cecostomy Catheters in Children

Abstract

Laparoscopic placement of Chait Trapdoor (Cook, Bloomington, IN) cecosotomy catheters has been practiced in our institution since 1999. Chait cecostomy catheters allow antegrade irrigation of the colon without the complications associated with appendicostomies. Although the use of laparoscopy allows precise placement of these catheters into the cecum under direct vision, the presence of a concomitant ventriculoperitoneal (VP) shunt raises concerns for the potential for a shunt infection. This is a retrospective review of all patients with VP shunts who underwent laparoscopic placement of a Chait cecostomy catheter from 1999 to 2008. We recorded patient demographics, indication for VP shunt placement, the date of the most recent shunt operation, the method of cecal fixation, follow-up duration, and episodes of shunt infection. Sixteen patients with spina bifida and VP shunts who underwent laparoscopic placement of a Chait cecostomy catheter were identified. There were 12 males. Mean follow-up was 46 +/- 27 months (range, 3-87). Two patients (12.5%) developed a VP shunt infection related to the placement of their cecostomy catheter. One shunt infection occurred 5 days postoperatively and the other occurred several years later, when the shunt and cecostomy catheter tracts merged in the subcutaneous tissue. Both patients underwent shunt externalization. Cecostomy catheter placement in patients with preexisting VP shunts may increase the risk of shunt infections. Our series illustrates two different mechanisms by which a VP shunt can become infected after this procedure. In the first case, leakage of enteric content from a poorly sealed tract probably resulted in the shunt infection. More secure fixation of the cecum to the abdominal wall, using intracorporeal sutures rather than T-fasteners, may avoid this complication. The second complication could have been avoided if the cecostomy catheter had been placed further away from the VP shunt.