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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109
Volume 11, Issue 1, May 2014 pp 17-24
Study of Surgical Intervention in Patient of Meningocele with Hydrocephalus: Simultaneous V/S Sequential Group
D. B. Katikar1, R. D. Jaykar2, Mahendra Kamble3, Sumeet Agrawal4
1Assistant Professor, 2Associate Professor,3,4Resident Doctors
Department of General Surgery, Dr.V.M. Government Medical College, Solapur, Maharashtra, INDIA.
Academic Editor : Dr. Aher K.R.
Background: Meningocele is sac protruding from the spinal column, Myelomeningocele is most severe type of spina bifida, which is commonly encountered by surgeon in new born due to failure of caudal neurulation. The incidence of meningocele is 0.2-2/1000 live births, and 15-25% of neonates with myelomeningocele have hydrocephalus at birth. Hence required significant amount of medical intervention, about 80-90% of them need shunt procedure. Methods: For all patients evaluation plan was as follows: Detail clinical history followed by thorough clinical examination. Investigations: Routine laboratory investigation required for pre anesthetic checkup such as Hemogram, Blood sugar level, Serum electrolytes, Blood urea level, Serum creatinine, Serum bilirubin; Ultrasonography (local, abdomen and pelvis, cranium); CT scan head. Consent: A written informed consent for surgery as per the risk was obtained from parents of patients. Pre-Operative Treatment: One dose of pre-operative antibiotic i.v Ceftriaxone 100mg/kg before operation. Anaesthesia: General anaesthesia Procedure: a) Low pressure V.P Shunt was used. b) Skin closure with 2-0 Nylon in both the procedures. Post-operative Treatment: All the patients from both the study groups were given- Antibiotics - I.V Ceftriaxone 100mg/kg x 5 days I.V Amikacin 15mg/kg x 5 days Local care -dressing on day 3, 5 and on wards if required Postoperative: Each patient’s operative time requirement for both study groups was recorded. The operative time was considered as the time from skin incision to the application of dressing. Patients were discharged after the operation as per their comfort and instructed to follow up on for suture removal. Patients were followed up at every week for two week, then on fourth week, eighth week and three months after discharge on outpatient department basis. Problems expected during postoperative period were: 1. Local wound infection. 2. Non healing of the wound. 3. Dehiscence of the wound. 4. Meningitis. 5. Ventriculitis. 6. Shunt failure. Local infection leading to septicaemia: In our comparative study, we had compared 40 patients of meningocele with hydrocephalus operated in one stage group and in two stage group. All patients were infants with age less than seven days. The meningocele sac was more commonly situated in lumbosacral region in our study groups. Our average operative time for single stage group was 105 min and average operative time for two stage group was 135 mins. The average hospital stay for single stage group was 10 days and two stage group was 22 days. We had two mortalities in our study, one each for both groups. Both the children developed septicemia and meningitis in spite of aggressive antibiotics treatment, they succumbed. We had complications like fever, local wound dehiscence and cerebrospinal fluid leak, none of which were life threading and all got corrected with appropriate treatment. The incidence in both group was almost similar. Both the procedure appeared to be equally safe and the complication rates were similar. The operative timing and hospital stay was less in one stage procedure which makes it economical and emotional burden lessens for the patients family. If the child appears to be fit and undergoes one stage procedure, it appears to be safe economical and without additional complication. Conclusion: Our comparative study revealed as 1. Mean operative time was less in one stage procedure than two stage procedure. 2. Hospital stay in one stage procedure was less than two stage procedure. 3. Complications rate in both the group were comparable. 4. One stage procedure enhanced flap survival and prevented CSF leakage. 5. It can be safely done, 6. It is economical and shortens hospital stay. 7. It avoided need for second aneasthetic administration. 8. It leads to reduction in hospital burden and patient morbidity. 9. Complication such as CSF leakage, wound dehiscence and shunt infection were comparable.
Children who are having meningocele and hydrocephalus can be operated by either one stage procedure or two stage procedure. Both the procedures appear to be equally safe and the complication rate was similar. The operative timing and hospital stay was less in one stay procedure which makes economical and emotional burdens less for the patient’s family. If the child appears to be fit, and undergoes one stage procedure, it appears to be safe, economical and without additional complication. A bigger sample size would be needed to validate their finding. Simultaneous surgery had the advantages of exposing these children to ones rather than twice for anaesthesia.