Preventing Distal Catheter Obstruction in Laparoscopic Ventriculoperitoneal Shunt Placement in Adults: The “Falciform Technique”

Svoboda, Shane; Park, Habeeba; Naff, Neal J.; Dorai, Zeena; Williams, Michael A.; Youssef, Yassar

doi:10.1089/lap.2015.0196

Cited by 17 publications

(12 citation statements)

References 11 publications

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“…Distal shunt failure is defined as any distal catheter-related problem that requires a return to surgery for management, such as shunt malfunction, displacement, misplacement, malposition, dislocation, and obstruction. It is reported in case series to occur in 0%-15.7% of laparoscopically inserted peritoneal catheters 1,5,6,9,13,20,35,37 and in 6%-28.7% of mini-laparotomy inserted catheters. 18,28 In this meta-analysis, the pooled data also show that the laparoscopic method significantly decreased the rate of distal shunt failure, which could be attributed to 2 main reasons, one being that the laparoscopic technique could prevent the distal shunt end from preperitoneal placement and confirm its efficacy simultaneously by direct vision.…”

Section: Discussionmentioning

confidence: 98%

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

Ouyang

Wang

et al. 2016

FOC

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OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.

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Section: Discussionmentioning

confidence: 98%

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

Ouyang

Wang

et al. 2016

FOC

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“…Rengachary performed a transthoracic transdiaphragmatic ventriculoperitoneal shunt, inserting the distal tube into the infradiaphragmatic suprahepatic space [19]. Svoboda used the falciform ligament to fix the distal catheter above the liver and thus avoid the free movement of the tube within the peritoneal cavity [20].…”

Section: Discussionmentioning

confidence: 99%

Our initial experience with ventriculo-epiplooic shunt in treatment of hydrocephalus in two centers

Grigorean

Sandu

Popescu

et al. 2017

Neurologia i Neurochirurgia Polska

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“…Distal mechanical malfunctions comprise 25–30% of all failures ( 10 ). Therefore, various techniques have been developed for placing the distal ends of the shunts, including mini-laparotomy, using a trocar to penetrate the abdominal wall layers and peritoneum and laparoscopy ( 11 ). The majority of these novel methods still involve positioning the VPS tube in the peritoneal or pelvic cavities.…”

Section: Discussionmentioning

confidence: 99%

“…The liver falciform ligament was selected in this novel procedure as a natural support for the catheter end due to its unique anatomic features ( 12 ). This position has no omental structures and placing the catheter in this area may prevent engulfment or coiling within the greater omentum ( 13 ), particularly in patients with shunt tube adjustments and a history of abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

Novel type of peritoneocentesis trocar-assisted distal ventriculoperitoneal shunt placement with supervision via a one-port laparoscope

Wang

Luan

et al. 2017

Experimental and Therapeutic Medicine

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Ventriculoperitoneal shunts (VPS) are the primary treatment for hydrocephalus and are associated with a high risk of complications, specifically in patients who are obese or have abdominal adhesions or shunt revisions. The present study describes the use of a novel type of peritoneal catheter peritoneocentesis trocar insertion with the assistance of a one-port laparoscope. A total of 36 patients with hydrocephalus underwent this novel type of peritoneocentesis trocar-assisted VPS. The distal shunt catheter was placed into the right subdiaphragmatic space and the catheter was traversed through a single hole drilled through the liver falciform ligament. The duration of the laparoscopic surgery ranged from 6–18 min (mean 10.4±1.6 min). No shunt-related infections or catheter malfunctions or injuries to the intra-abdominal organs occurred. The total abdominal incision length was 1.0 cm (0.5+0.5 cm). No laparoscopy-related complications were observed during follow-up assessments. The novel approach used in the current study is very easy to perform, and this method may significantly reduce the risk of malfunction complications. The presented method also has the advantages of reduced trauma and a simpler surgery. The current study indicated that this simple, minimally invasive procedure was beneficial for patients with hydrocephalus, specifically in cases of patients with obesity, peritoneal adhesions or shunt revisions.

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Preventing Distal Catheter Obstruction in Laparoscopic Ventriculoperitoneal Shunt Placement in Adults: The “Falciform Technique”

Cited by 17 publications

References 11 publications

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

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

Our initial experience with ventriculo-epiplooic shunt in treatment of hydrocephalus in two centers

Novel type of peritoneocentesis trocar-assisted distal ventriculoperitoneal shunt placement with supervision via a one-port laparoscope

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