AANS Beyond 2021: Scientific Papers Collection-Complications Associated with Gastronomy and Ventriculoperitoneal Shun Placement

Video Transcription

Hello, my name is Gareth Gilman. I'm a general surgery resident at the University of Miami Hospital System and Jackson Memorial Hospital under the guidance of my mentor, Dr.  Chad Thorson and Heather McCray within the Department of Pediatric Surgery and Pediatric Neurosurgery, I am pleased to present complications associated with gastrostomy and ventricular peritoneal shunt placement.  Pediatric patients requiring ventricular peritoneal or VP shunts often require gastrostomy tubes or G-tubes as well.  G-tube placement during the same hospitalization is associated with increased VP shunt complications and failure.  The influence of G-tube placement method on shunt complications is unknown.  For our methods, the nationwide readmission database was queried from 2010 to 2014 for patients under the age of 18 who underwent G-tube and VP shunt during their index admission.  Over the five-year period, 626 patients were identified. 47% were newborn and 51% were female. For surgical approach, open was the most common method of G-tube placement.  G-tube complications were seen in 13%, most commonly localized infection. Suspected shunt infection requiring TAP occurred in 2012.  Overall, VP shunt revision rate was 35%. 60% required removal at index hospitalization.  Median time to VP shunt revision was 15 days from discharge. The readmission rate for this population was 15 days from discharge.  The shunt complications requiring TAP occurred in 21%, of which 74% required removal at index hospitalization. Overall, VP shunt revision rate was 35%.  60% required VP shunt revision at readmission. The median time to VP shunt revision was 15 days from discharge.  The readmission rate for this population was 26% at 30 days and 48% within a year. The readmission rate was lower for patients undergoing laparoscopic G-tubes.  Newborns were more likely than older children to require VP shunt revision at readmission.  Newborns undergoing laparoscopic G-tubes were less likely to require VP shunt revisions at readmission.  In conclusion, VP shunt complications are common with placement of G-tubes during the same hospitalization.  The readmission for shunt revision is more common in newborns after open procedures or PEG.  Specialist consideration should be given to use of laparoscopy due to improved outcomes and less complications. Thank you for your time and thank you to my research team.  I look forward to any comments or questions.

Video Summary

In the video, Dr. Gareth Gilman presents complications associated with gastrostomy and ventricular peritoneal (VP) shunt placement in pediatric patients. Gastrostomy tube (G-tube) placement alongside VP shunts increases the risk of complications and failure. The research team analyzed data from the nationwide readmission database of patients under 18 years old who had G-tube and VP shunt during the same hospitalization. Out of 626 patients identified over five years, 13% experienced G-tube complications, most commonly localized infection. Shunt complications occurred in 21% of cases, leading to a 35% revision rate, and readmission rates were 26% at 30 days and 48% within a year. Laparoscopic G-tube placement had better outcomes and reduced complications in newborns compared to open procedures. Specialist consideration is advised for the use of laparoscopy. No specific credits were mentioned.

Keywords

complications

gastrostomy

VP shunt placement

readmission rates

laparoscopic G-tube placement