Laparotomy versus Laparoscopic Placement of Distal Catheter in Ventriculoperitoneal Shunt Procedure

Abstract

Objective : Traditionally, peritoneal catheter is inserted with midline laparotomy incision in ventriculoperitoneal (V-P) shunt procedures. Complications of V-P shunt is not uncommon and have been reported to occur in 5-37% of cases. The aim of this study is to compare the clinical outcomes and the operation time between laparotomy and laparoscopic groups. Methods : A total of 155 V-P shunt procedures were performed to treat hydrocephalic patients of various origins in our institute between June 2006 to January 2010; 95 of which were laparoscopically guided and 65 were not. We reviewed the operation time, surgery-related complications, and intraoperative and postoperative problems. Results : In the laparoscopy group, the mean duration of the procedure (52 minutes) was significantly shorter (p < 0.001) than the laparotomy group (109 minutes). There were two cases of malfunctions and one incidence of diaphragm injury in the laparotomy group. In contrast, there were neither malfunction nor any internal organ injuries in the laparoscopy group (p = 0.034). There were total of two cases of infections from both groups (p = 0.7). Conclusion : Laparoscopically guided insertions of distal shunt catheter is considered a fast and safe method in contrast to the laparotomy technique. This method allows the exact localization of the peritoneal catheter and a confirmation of its patency.

Antimicrobial-impregnated and -coated shunt catheters for prevention of infections in patients with hydrocephalus: a systematic review and meta-analysis

“…15 Several efforts have been made to reduce the incidence of CSF catheter implantation-associated infections, such as using minimal handling protocols, including changing gloves before handling the catheter and laparoscopic placement of the distal catheter instead of conventional laparotomy. 32,38 Perioperative antibiotic prophylaxis, antibiotic-impregnated sutures for wound closing, and topical application of methicillin to the operative field have also been shown to reduce infections associated with CSF catheter implantation. 37,42,45 The development of antimicrobial-impregnated and -coated catheters (antimicrobial catheters)-including antibiotic-impregnated catheters (AICs), silver-coated catheters (SCCs), and hydrogel-coated catheters (HCCs)-has been among the most promising advances.…”

Ventriculoperitoneal shunting: Laparoscopically assisted versus conventional open surgical approaches

“…[3151618192131323738414243] Nevertheless, obesity, previous abdominal operation and distorted abdominal anatomy seem to correlate straightly with the rate of distal mechanical shunt failure due to adhesions, calcification and fibrosis causing distal catheter obstruction, malposition and migration. In our study, distal catheter malfunction which resulted in shunt failure occurred only in 8 (3.5%) of cases, without significant difference between the two groups [Table 2].…”

Incisional hernia after ventriculoperitoneal shunt

“…In addition, laparoscopic placement of the shunts allows for confirmation of shunt patency and function by direct visualization of CSF flow from the shunt tubing [10]. The advantages of the laparoscopic approach also include a shorter hospital stay, less post-operative pain, lower chance of incisional hernia formation, and, since the catheter is positioned under direct vision with minimal bowel manipulation, there is a much lower chance of bowel injury and adhesion formation [6,8]. Even when dealing with complications, laparoscopy offers a distinct advantage over laparotomy, especially in terms of superior visualization of the peritoneal cavity, retrieval of displaced shunts, lysis of adhesions, culture of abdominal fluid, repositioning of displaced tubings, and assessing the abdomen for any other pathology [2][3][4]6,8,10].…”

“…With its advantage of better vision and less tissue trauma, laparoscopic placement of the abdominal end of the shunt is rapidly becoming accepted as a procedure of choice, and has reportedly brought down the incidence of complications at the distal end [3,4,6,[8][9][10]. In addition, laparoscopic placement of the shunts allows for confirmation of shunt patency and function by direct visualization of CSF flow from the shunt tubing [10].…”

“…Complications that occur at the distal (abdominal) end are also a cause of significant morbidity, and in various series, nearly 5 -47 % of all shunt failures are thought to be due to malfunction of the distal catheter [4][5][6][7] with a higher incidence in patients with scoliosis, obesity and those who have undergone prior abdominal surgery [4,8]. Abdominal complications that have been reported are; shunt infection, development of an inguinal hernia, subcutaneous collections of CSF, peritoneal or omental cyst formation, mesenteric pseudotumors, bowel perforation, intestinal volvulus around the shunt tubing, catheter disconnection; and various types of catheter migrations such as extraperitoneal retraction and displacement, migration of the catheter into the pleural cavity or heart, or protrusion of the catheter through the mouth, umbilicus, bladder, vagina, anus, or scrotum.…”