Laparoscopy versus mini-laparotomy peritoneal catheter insertion of ventriculoperitoneal shunts: a systematic review and meta-analysis

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25–0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8–23), operative time was shorter (mean difference [MD], −12.84; 95% CI −20.68 to −5.00; p = 0.001), and blood loss was less (MD −9.93, 95% CI −17.56 to −2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD −1.77, 95% CI −3.67 to 0.13; p = 0.07).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant.</jats:p></jats:sec>

Neuronavigated and Laparoscopic-Assisted Ventriculoperitoneal Shunt Placement

“…The more minimally invasive technique decreases the length of stay in the hospital as well as prompts a faster recovery rate [9,14]. This allows for less resource use by individual patients and increased patient satisfaction by leaving the hospital soon after surgery and returning to regular activities faster than with the mini-laparotomy technique [9,11,14].…”

“…Finally, shunts are subject to various infections, the majority arising from normal skin flora and occurring within 30 days of surgery [3]. Current studies suggest an overall infection rate of 8.4% and a shunt failure rate, defined as a catheter-related problem necessitating surgical intervention [9], of 51.4% [10]. It has been shown that patients require 2-3 surgical revisions on average due to shunt failures in the 20 years after the original shunt placement [8], with the majority of shunt revisions occurring in the first 6-12 months [4,8].…”

“…With time, the frequent revision rates and complications have provoked multiple changes and advancements in both VP shunt equipment, including the catheters and valve mechanisms [9,13], as well as the surgical procedure itself [9]. Traditionally, VP shunts have been inserted using mini-laparotomy, although recently, a neuronavigated laparoscopically assisted approach has become a more commonly accepted surgical technique [9,14].…”

“…With time, the frequent revision rates and complications have provoked multiple changes and advancements in both VP shunt equipment, including the catheters and valve mechanisms [9,13], as well as the surgical procedure itself [9]. Traditionally, VP shunts have been inserted using mini-laparotomy, although recently, a neuronavigated laparoscopically assisted approach has become a more commonly accepted surgical technique [9,14]. Multiple studies have demonstrated that relative to the mini-laparotomy technique, a laparoscopically assisted approach has a shorter operative time and length of stay in the hospital, a decreased distal shunt failure rate [4,9,14], and a decreased risk of visceral injury [10].…”

“…Traditionally, VP shunts have been inserted using mini-laparotomy, although recently, a neuronavigated laparoscopically assisted approach has become a more commonly accepted surgical technique [9,14]. Multiple studies have demonstrated that relative to the mini-laparotomy technique, a laparoscopically assisted approach has a shorter operative time and length of stay in the hospital, a decreased distal shunt failure rate [4,9,14], and a decreased risk of visceral injury [10]. Laparoscopy has also been shown to offer favorable outcomes with smaller incisions leading to reduced post-operative pain [11], faster mobilization and a preferred cosmetic appearance [5].…”