Risks of Surgery for Myelomeningocele in Children
Keywords:MMC, Wound dehiscence, Complications, Spinal dysraphism, Hydrocephalus, V/P shunting
Objective: To know about complications in Myelomeningocele (MMC) surgery.
Material and Methods: Fifty five children underwent surgical repair of MMCs and represent our experience about complication in surgery for MMC. Retrospective observational study carried out in Neurosurgery ward, Lady reading hospital Peshawar, from 2013 to 2015. Patients suffering from MMC were admitted. The clinical, radiological and laboratory finding of patients were documented on a designed proforma. Moreover ventri-culoperitonial shunting (V/P) was performed for children who had or developed hydrocephalus. Eliptical incision in vertical plane was given in 45 cases and horizontal incision in 6 cases. Plastic surgery unit consulted for very large MMC in rest of 4 cases and transposition of gluteus maximus musculocutaneous unit performed. All patients with MMC of both gender and age range from 1 month to 10 years who were willing and fit for surgery were included in this study and all those who were not willing and fit for surgery were excluded. The study was approved by Institute of Research in Ethics and Biomedicine (IREB).This study will help to make recommen-dations.
Results: Patients in this study were in the age range of 1 month to 10 years. Mean age was 1.8 years. Thirty seven patients (67%) were Paraparetic (MRC grade from 1 to 4) and 18 patients (32.72%) were completely paraplegic. Seventeen patients (30.9%) had ruptured MMC at presentation and underwent surgery in emergency. Fifteen patients (27.27%) had V/P shunting before surgery for MMC and 11 patients (20%) developed hydro-cephalus after excision and repair of MMC and V/P shunting carried out. Seven patients (12.72%) developed wound dehiscence and CSF leak and subjected to redo surgery. Three patients (5.45%) had wound infection followed by meningitis and two patients (3.63%) died after surgery.
Conclusion: From this study we concluded that wound dehiscence and CSF leak are the most common complication after surgery for MMC and can be prevented by tensionless closure of the wound. In MMC patients with overt hydrocephalus prior to repair and excision of MMC V/P shunting should be performed. If patient develop hydrocephalus after surgery then immediate diversion of CSF should be carried out.
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