Laparoscopic Management of Post Operative Obstructed Distal End of Ventriculoperitoneal Shunt Tube in Hydrocephalic Patients

Abstract

Background: Hydrocephalus is a common condition in which there is an abnormal accumulation of cerebrospinal fluid in the brain. Ventriculoperitoneal (VP) shunt surgery is a standard treatment for hydrocephalus, but post-operative obstructed distal ends of VP shunt tubes can lead to complications.Laparoscopy has emerged as a potential diagnostic and therapeutic tool in managing such obstructions. This study aimed to comprehensively outline the role of laparoscopy in the diagnosis and management of obstructed distal ends of VP shunt tubes in hydrocephalic patients. Methods: The study was conducted at Benha University and Benha Children Hospitals between 2016 and 2021. A cohort of 40 hydrocephalic patients who had undergone VP shunt surgery and experienced abdominal obstruction at the distal end of their VP shunts were included. Diagnosis involved clinical abdominal examination, neurosurgical evaluation, and radiological examinations (abdominal X-ray, abdominal ultrasound, and brain CT scan). Laparoscopic procedures were performed to address the specific obstructions. Results: Among the 40 patients, laparoscopy successfully diagnosed and treated the obstructed distal ends of VP shunt tubes in 31 cases (77.5%). The laparoscopic interventions resulted in resolution of symptoms and signs of active hydrocephalus in these patients, as confirmed by radiological assessments. Out of the remaining 9 cases, 6 required additional laparoscopic revisions, while 3 patients were prepared for ventriculo-arterial shunts. No conversions to open surgery were needed, and there were no mortality cases. Mild post-operative complications were observed in 6 patients, which resolved with antibiotic and antipyretic therapy. Conclusions: Laparoscopy is a valuable diagnostic and therapeutic approach in the management of obstructed distal ends of VP shunt tubes in hydrocephalic patients.