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Sanderfer VC, Arnold MR, Mulvaney GG, Wang H, McLanahan CS, Wait SD, Van Poppel MD, Cosper G, Schmelzer T, Schulman AM, Jernigan SC, Reinke CE. Outcomes of laparoscopic and open ventriculoperitoneal shunt placement. Am J Surg 2024; 227:123-126. [PMID: 37827869 DOI: 10.1016/j.amjsurg.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Ventriculoperitoneal (VP) shunt placement requires a concurrent abdominal procedure. For peritoneal access laparoscopic or open approach may be utilized. Our aim was to compare patient/procedure characteristics and outcomes by peritoneal approach for VP shunts in children. METHODS NSQIP-Pediatric procedure targeted cerebral spinal fluid shunt Participant Use Data Files from 2016 to 2020 were queried. Patients were grouped into laparoscopic vs open abdominal approach. Patient demographics, procedure characteristics and 30-day outcomes were compared. RESULTS 7742 NSQIP-Pediatric patients underwent VP shunt placement. Patients undergoing laparoscopic approach were older and required less preoperative support. Mean operative time was longer with laparoscopy (mean(SD): 74.2(48.1) vs. 64.6(39) minutes, p < 0.0001) but had shorter hospital LOS. There was no difference in SSI, readmissions, or reoperation rates. CONCLUSION Patients undergoing laparoscopy for distal VP shunts are older with less support needs preoperatively. While laparoscopic approach had a shorter hospital LOS, there was no demonstratable difference in SSI, readmissions or reoperations between approaches. Further studies are needed to assess long-term outcomes.
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Affiliation(s)
| | - Michael R Arnold
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Graham G Mulvaney
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Huaping Wang
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | | | - Scott D Wait
- Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA
| | | | | | | | | | | | - Caroline E Reinke
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.
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Ding Q, Wang J, Fan H, Jiang W, Guo H, Ji H, Song T, Xu S, Liu B. Introduction and comparision of three different fixation methods in the suprahepatic space in laparoscopy-assisted ventriculoperitoneal shunt for hydrocephalus. Sci Rep 2023; 13:6231. [PMID: 37069252 PMCID: PMC10110567 DOI: 10.1038/s41598-023-33566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/14/2023] [Indexed: 04/19/2023] Open
Abstract
Ventriculoperitoneal shunt (VPS) placement is the standard procedure in the management of hydrocephalus. The introduction of laparoscopy allows better visualization during the operation and a more reliable placement of the peritoneal terminal of the catheter, which significantly decreases postoperative obstruction and malposition rates. However, the fixation methods of the peritoneal terminal of the catheter have not been previously discussed. The indications, techniques, and complications were compared between conventional VPS and laparoscopy-guided VPS. Furthermore, same analyses were performed within the laparoscopy-guided VPS group subdivided by three different techniques of the fixation of the peritoneal terminal of catheter, including suture and ligature, titanium clip fixation, and subcutaneous fixation. A total of 137 patients with hydrocephalus who received VPS treatment was retrospectively studied, 85 of which were laparoscopy-guided, and 52 were not. The distal ends of the catheters were all placed in the suprahepatic space. At least one year (mean 28.6 months) follow-up was given postoperatively. The average duration of the whole operation was 45 min for suture and ligature, 40 min for titanium clip fixation, and 30 min for the subcutaneous fixation, respectively. Six patients (4.4%) had obstructive of the ventricular catheter in total. The success rates for the laparoscopy-assisted VPS procedure and the conventional VPS procedure were 87.1% (74/85) and 80.8% (42/52), respectively. Within subgroups of the laparoscopy-assisted VPS divided by fixation methods, the procedures were successful in 85.2% (23/27) of suture and ligation, 82.1% (23/28) of titanium clip fixation, and 93.3% (28/30) of subcutaneous fixation, respectively. Two patients had dislocated shunt tube in peritoneal end in laparoscopy group, all in the titanium clip fixation subgroups. The laparoscopy-assisted VPS insertion is an ideal shunt method for its effectiveness and lesser complication rate after operation. The subcutaneous fixation method of the peritoneal terminal of catheter might be the optimal fixation technique.
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Affiliation(s)
- Qian Ding
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Jinchao Wang
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Haitao Fan
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Wanli Jiang
- First School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
- Department of Medical Imaging, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
| | - Hua Guo
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Hongsheng Ji
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Tao Song
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Shangchen Xu
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Bin Liu
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
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Alawamry A, Youssef EM, Morsy AA, Ashour H, Samir MA. Laparoscopic-assisted intraperitoneal placement of lumboperitoneal shunt in patients with idiopathic intracranial hypertension. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-022-00184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Abstract
Background
Lumboperitoneal (LP) shunting is an effective treatment option aiming at cerebrospinal fluid diversion in cases of idiopathic intracranial hypertension. Confirming the distal end position, on the other hand, could be technically difficult, especially in obese people. With minimal invasive procedures, laparoscopic-assisted placement of the peritoneal side of the LP shunt became a valid treatment option. In this study, we aim to evaluate the operation duration, possible complications, and patient outcomes after the placement of a peritoneal catheter using the laparoscopically assisted technique.
Methods
A retrospective analysis of clinical, preoperative, and postoperative data for 18 patients diagnosed with idiopathic intracranial hypertension and undergoing LP shunt surgery using the laparoscopic-assisted technique for intraperitoneal catheter placement between 2019 and 2021 was performed.
Results
The average operating time was 93.89 min, and the average hospital stay was 2.3 days. There was no mortality among cases treated with the described technique, and no intraoperative complication occurred. Seven patients (38.9%) had LP shunt failure, with a median duration to failure of 212 days; three cases for slippage, two cases had over drainage, one case had peritoneal adhesions around the shunt tip, and one case had Arnold Chiari malformation.
Conclusions
The laparoscopic assisted technique is safe and feasible. It allowed a direct vision of the shunt tip position within the peritoneal cavity which helped in confirming position and assessing function, resulting in a superior option over classic surgical options. Short hospital stay, minimal postoperative pain, and low failure rates are the main advantages of described technique.
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Ho Y, Chiang W, Huang H, Lin S, Tsai S. Effectiveness and safety of ventriculoperitoneal shunt versus lumboperitoneal shunt for communicating hydrocephalus: A systematic review and meta-analysis with trial sequential analysis. CNS Neurosci Ther 2023; 29:804-815. [PMID: 36650662 PMCID: PMC9928545 DOI: 10.1111/cns.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The current standard surgical treatment for cerebrospinal fluid diversion is a ventriculoperitoneal shunt (VPS) implantation. Lumboperitoneal shunts (LPS) are an alternative treatment for communicating hydrocephalus. Prior studies comparing these two included a limited number of participants. METHODS We performed a meta-analysis determined the treatment failure, complications and effectiveness of lumboperitoneal shunt for communicating hydrocephalus. We reviewed studies with clinical and imaging diagnoses of communicating hydrocephalus, all causes and subtypes of communicating hydrocephalus, and studies that analyzed the primary and secondary outcomes listed below. We included randomized controlled trials (RCTs), non-RCTs and retrospective studies. We performed the meta-analysis in R, using a random-effects model and reporting 95% confidence intervals. RESULTS Data from 25 studies, including 3654 patients, were analyzed. The total complication rates were 12.98% (188/1448) for lumboperitoneal shunt and 23.80% (398/1672) for ventriculoperitoneal shunt. The odds ratio for lumboperitoneal shunt versus ventriculoperitoneal shunt complication rates was 0.29 (95% CI 0.19 to 0.45, p < 0.0001), and the I2 was 72%. The shunt obstruction/malfunction rate was 3.99% (48/1204) for lumboperitoneal shunt and 8.31% (115/1384) for ventriculoperitoneal shunt (Odds ratio 0.54, 95% CI 0.37 to 0.79, p = 0.002, I2 = 0%). Based on the Modified Rankin Scale score, there were no differences in effectiveness between lumboperitoneal shunt and ventriculoperitoneal shunt. Nevertheless, lumboperitoneal shunt improved radiological outcomes. CONCLUSIONS This analysis demonstrated that lumboperitoneal shunt is a safe and equally effective choice for treating communicating hydrocephalus. More studies are needed to confirm the safety of lumboperitoneal shunt.
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Affiliation(s)
- Yi‐Jen Ho
- Department of Neurosurgery, Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationHualienTaiwan
| | - Wen‐Chun Chiang
- Department of Chest Medicine, Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationHualienTaiwan
| | - Hsin‐Yi Huang
- Department of Medical Research, Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationHualienTaiwan
| | - Shinn‐Zong Lin
- Department of Neurosurgery, Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationHualienTaiwan,School of MedicineTzu Chi UniversityHualienTaiwan
| | - Sheng‐Tzung Tsai
- Department of Neurosurgery, Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationHualienTaiwan,School of MedicineTzu Chi UniversityHualienTaiwan
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Mulvaney G, Arnold M, Reinke C, Wait S, Van Poppel M, McLanahan S, Schmelzer T, Cosper G, Schulman A, Jernigan S. Laparoscopic Co-surgeon Ventriculoperitoneal Shunt Placement Versus Single Surgeon Mini Laparotomy. Cureus 2022; 14:e26057. [PMID: 35747114 PMCID: PMC9209392 DOI: 10.7759/cureus.26057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: Ventriculoperitoneal (VP) shunt placement is one of the most common treatments for pediatric hydrocephalus. However, device failures often occur, requiring operative revision of either the intraventricular or intraperitoneal shunt catheters. Historically, shunt placement was performed via laparotomy, but there has been a trend towards laparoscopic-assisted placement of the intraperitoneal portion of the shunt. We examined the outcomes of laparoscopic-assisted versus open VP shunt placement utilizing a local institutional retrospective review. Methods: Single institution 2012-2017 retrospective review of all cases was performed. Patients were divided into two groups - laparoscopic and open. Thirty-day outcomes, patient age, surgery performed, surgical control time (SCT), length of stay (LOS), and readmission were analyzed. Results: Cohort analysis inclusion criteria included 188 patients. The cohort analysis showed both decreased laparoscopic-assisted SCT (56.4 vs 32.1 min, p<0.0001) and postop complications (16.7% vs 7.1%, p<0.07). There was no significant difference in surgical site infection or readmission rates. Conclusion: Local analysis show advantages for laparoscopic-assisted VP shunt placement over open single surgeon techniques with decreased SCT, LOS, and unplanned interventions.
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Percutaneous abdominal puncture for catheterization with the assistance of guide wire in lumboperitoneal shunt. World Neurosurg 2022; 165:1-5. [PMID: 35717013 DOI: 10.1016/j.wneu.2022.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022]
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Li Z, Wang H, Zhang H, Yang J, Yang X, Wen L. Lumboperitoneal shunt surgery via continuous two-stage procedure: Technique notes and outcomes. Front Neurol 2022; 13:1059316. [PMID: 36561303 PMCID: PMC9763887 DOI: 10.3389/fneur.2022.1059316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Background Lumboperitoneal shunt (LPS) is an effective procedure for managing communicating hydrocephalus. LPS is performed as a one-stage procedure with the patient placed in the lateral position or as a two-stage procedure in which the patient's position is changed. Both methods can be bothersome to neurosurgeons. We designed a continuous two-stage LPS procedure in which the operative sites did not need to be sterilized again, and the surgical drapes did not have to be changed after changing the patient's position. In this study, we analyzed this procedure in terms of the technical features and outcomes. Methods All patients from our institute who underwent LPS using the continuous two-stage procedure from October 2019 to August 2021 were reviewed retrospectively. The patient's demographic information, clinical features, operative data, and outcomes were analyzed. Results A total of 46 consecutive patients who underwent LPS using the continuous two-stage procedure were enrolled. The mean operative duration was 70.6 ± 12.7 min. The 180-day revision rate for these patients was 2.2% (1/46). Moreover, 76.1% of the patients (35/46) experienced clinical improvement after LPS during the 180-day follow-up, and 70.0% of the patients (32/46) experienced an improvement in neuroimaging. Conclusion We described a continuous two-stage LPS procedure. This method simplified the two-stage LPS procedure and maintained a low malfunction rate and shunt infection rate in our series.
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Affiliation(s)
- Zhao Li
- Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou, China
| | - Hao Wang
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Han Zhang
- Shengzhou People's Hospital, First Affiliated Hospital, School of Medicine, Zhejiang University, Shengzhou, China
| | - Jiqi Yang
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaofeng Yang
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Liang Wen
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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De Jesus O, Rios-Vicil C, Pellot Cestero JE, Carro-Figueroa EF. Huge subcutaneous extraperitoneal pseudocyst after migration of the ventriculoperitoneal shunt catheter. BMJ Case Rep 2021; 14:e246681. [PMID: 34853048 PMCID: PMC8638129 DOI: 10.1136/bcr-2021-246681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/03/2022] Open
Abstract
The formation of an intraperitoneal pseudocyst as a complication of ventriculoperitoneal shunts is well known. However, the formation of a pseudocyst at the subcutaneous extraperitoneal abdominal space is unusual and likely secondary to the migration of the peritoneal catheter. We present a 53-year-old male who had placement of a ventriculoperitoneal shunt for hydrocephalus secondary to a vestibular schwannoma. Five months later, he presented with an enormously distended abdomen. Investigations showed the peritoneal catheter in the extraperitoneal space within a large right lower quadrant abdominal wall pseudocyst. The patient was taken to the operating theatre, and the shunt was externalised at the original abdominal incision. Approximately 3 L of cerebrospinal fluid were aspirated from the distal peritoneal catheter. After negative cultures, a new peritoneal catheter was placed intraperitoneally at the contralateral lower abdominal quadrant. The contralateral quadrant was utilised to prevent fluid accumulation into the old extraperitoneal cavity.
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Affiliation(s)
- Orlando De Jesus
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Christian Rios-Vicil
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Joel E Pellot Cestero
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Eric F Carro-Figueroa
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
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Just Stick a Scope in: Laparoscopic Ventriculoperitoneal Shunt Placement in the Pediatric Reoperative Abdomen. J Surg Res 2021; 269:212-217. [PMID: 34600330 DOI: 10.1016/j.jss.2021.07.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/23/2021] [Accepted: 07/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ventriculoperitoneal shunt (VPS) placement into the reoperative abdomen can be challenging due to intraperitoneal adhesions. Laparoscopic guidance may provide safe abdominal access and identify an area for optimal cerebrospinal fluid drainage. The study aim was to compare laparoscopic-assisted VPS placement to an "open" approach in patients with prior abdominal surgery. MATERIALS AND METHODS A retrospective review was performed of children undergoing VPS placement into a reoperative abdomen from 2009-2019. Clinical data were collected, and patients undergoing laparoscopy (LAP) were compared to those undergoing an open approach (OPEN). RESULTS A total of 120 children underwent 169 VPS placements at a median age of 8 y (IQR 2-15 y), and a mean number of two prior abdominal operations (IQR 1-2). Laparoscopy was used in 24% of cases. Shunt-related complications within 30 d were lower in the LAP group (0% versus 19%, P = 0.001), as were VPS-related postoperative emergency department visits (0% versus 13%, P = 0.003) and readmissions (0% versus 13%, P = 0.013). Shunt malfunction rates were higher (42% OPEN versus 25% LAP, P = 0.03) and occurred sooner in the OPEN group (median 26 versus 78 wk, P = 0.01). The LAP group demonstrated shorter operative times (63 versus 100 min, P < 0.0001), and the only bowel injury. Time to feeds, length of stay, and mortality were similar between groups. CONCLUSIONS Laparoscopic guidance during VPS placement into the reoperative abdomen is associated with a decrease in shunt-related complications, longer shunt patency, and shorter operative times. Prospective study may clarify the potential benefits of laparoscopy in this setting.
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Goto Y, Oka H, Nishii S, Takagi Y, Yokoya S, Hino A. Lumboperitoneal shunt surgery via lateral abdominal laparotomy. J Neurosurg Spine 2020; 32:548-553. [PMID: 31860824 DOI: 10.3171/2019.10.spine19957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE One of the technical problems encountered in performing lumboperitoneal shunt (LPS) surgery involves operative positioning of the patient. To insert the spinal catheter into the subarachnoid lumbar space, LPS is usually performed with the patient in the lateral decubitus position. However, laparotomy around the periumbilical region, especially in obese patients in the lateral decubitus position, can be quite difficult. Thus, the authors added a simple modification to the laparotomy for LPS, altering the laparotomy site to the lateral side of the patient's trunk. The aim of this study was to analyze this method in terms of technical features and outcomes. METHODS Two LPS procedures were compared: routine periumbilical anterior abdominal laparotomy and our modified method using lateral abdominal laparotomy. The first 11 consecutive cases underwent routine anterior abdominal laparotomy with position changes or tilting of the operative bed, whereas the next 17 consecutive cases underwent lateral abdominal laparotomy not requiring position changes. RESULTS In the anterior abdominal laparotomy group, the mean operative time was 72.36 ± 24.63 minutes. One patient had a spinal tube tear that required revision of the LPS 2 years postoperatively. In the lateral abdominal laparotomy group, the mean operative time was 38.82 ± 13.87 minutes. One patient experienced a postoperative headache and exhibited a thin, chronic subdural hematoma on imaging studies, which disappeared after adjustment of the valve pressure. CONCLUSIONS In the current series, the operative duration was shorter in the lateral abdominal group compared with the anterior abdominal group, with no differences in complication rates. Lateral abdominal laparotomy simplifies LPS.
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