Laparoscopic versus non–laparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis

Roth, Jonathan; Sagie, Boaz; Szold, Amir; Elran, Hanoch

doi:10.1016/j.surneu.2006.10.069

Cited by 42 publications

(63 citation statements)

References 34 publications

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“…Roth et al speculated that the decreased rate of distal shunt obstructions in their laparoscopic group (4% vs 10.3% after mini-laparotomy) may have been due to less frequent dislocation out of the peritoneal cavity owing to a smaller peritoneal hole and lysing of adhesions during shunt placement. 25 Dislocation of the distal catheter out of the peritoneal cavity or inadvertent ligation of the catheter at the entry point into the peritoneum were the causes for all 5 distal shunt failures in our mini-laparotomy group. The method of entry into the peritoneal cavity is, however, the precise difference between the two surgical approaches.…”

Section: Reasons For Different Distal Failure Ratesmentioning

confidence: 73%

“…4 Roth et al reported distal shunt failure rates of 4% and 10.3% for laparoscopic and minilaparotomy methods, respectively, in a retrospective series. 25 A prospective, nonrandomized study reported rates of 4% after laparoscopic assistance compared with 12% after mini-laparotomy. 27 Hence, our study, in accordance with previous reports, shows that the problem of distal shunt failure is largely solved by the use of laparoscopy.…”

Section: Distal Shunt Failure (Abdominal Malposition and Distal Obstrmentioning

confidence: 99%

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Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial

Schucht¹,

Banz

Trochsler

et al. 2015

JNS

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OBJECT In ventriculoperitoneal (VP) shunt surgery, laparoscopic assistance can be used for placement of the peritoneal catheter. Until now, the efficacy of laparoscopic shunt placement has been investigated only in retrospective and nonrandomized prospective studies, which have reported decreased distal shunt dysfunction rates in patients undergoing laparascopic placement compared with mini-laparotomy cohorts. In this randomized controlled trial the authors compared rates of shunt failure in patients who underwent laparoscopic surgery for peritoneal catheter placement with rates in patients who underwent traditional mini-laparotomy. METHODS One hundred twenty patients scheduled for VP shunt surgery were randomized to laparoscopic surgery or mini-laparotomy for insertion of the peritoneal catheter. The primary endpoint was the rate of overall shunt complication or failure within the first 12 months after surgery. Secondary endpoints were distal shunt failure, overall complication/ failure, duration of surgery and hospitalization, and morbidity. RESULTS The overall shunt complication/failure rate was 15% (9 of 60 cases) in the laparoscopic group and 18.3% (11 of 60 cases) in the mini-laparotomy group (p = 0.404). Patients in the laparoscopic group had no distal shunt failures; in contrast, 5 (8%) of 60 patients in the mini-laparotomy group experienced distal shunt failure (p = 0.029). Intraoperative complications occurred in 2 patients (both in the laparoscopic group), and abdominal pain led to catheter removal in 1 patient per group. Infections occurred in 1 patient in the laparoscopic group and 3 in the mini-laparotomy group. The mean durations of surgery and hospitalization were similar in the 2 groups. CONCLUSIONS While overall shunt failure rates were similar in the 2 groups, the use of laparoscopic shunt placement significantly reduced the rate of distal shunt failure compared with mini-laparotomy.

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Section: Reasons For Different Distal Failure Ratesmentioning

confidence: 73%

Section: Distal Shunt Failure (Abdominal Malposition and Distal Obstrmentioning

confidence: 99%

Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial

Schucht¹,

Banz

Trochsler

et al. 2015

JNS

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“…The ability to visualize the entire peritoneal cavity also allows the retrieval of foreign bodies, lysis of adhesions and culturing of abdominal fluid. Also, the lysis of adhesions may decrease the need for pleural or atrial shunts [10][11][12][13]25,28,29) . In all patients, the insertion of the catheter within the abdominal cavity was performed with only one veress needle and one laparoscope with five millimeter trocar.…”

Section: Discussionmentioning

confidence: 99%

“…The pressure of cerebrospinal fluid (CSF) was examined after the deflating the peritoneum in order to avoid the deleterious effects of increased abdominal pressure on the intracranial pressure 14,22,25) . After connecting the valve with peritoneal and ventricular catheter, pneumoperitoneum was recreated.…”

Section: Procedures Descriptionmentioning

confidence: 99%

Laparotomy versus Laparoscopic Placement of Distal Catheter in Ventriculoperitoneal Shunt Procedure

Park

et al. 2010

J Korean Neurosurg Soc

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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.

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“…However, despite the fact that it is considered a minor invasive procedure, it does involve certain risks, such as hemorrhage, shunt malfunction, or infection (19)(20)(21); in addition, it may rarely result in peritoneal carcinomatosis due to seeding from the central nervous system (CNS) tumors (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Nevertheless, not all studies have encountered peritoneal seeding via VPS (16,30,40).…”

Section: Introductionmentioning

confidence: 99%

Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

Nigim

Critchlow

Kasper

2015

Molecular and Clinical Oncology

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Abstract. Approximately 1-5% of patients with cerebral metastasis and ~40% of patients with primary brain tumors suffer from hydrocephalus. These patients often exhibit a poor prognosis. The aim of the present study was to reassess the validity of ventriculoperitoneal shunting (VPS) with the assistance of the general surgeon in oncological patients. A total of 59 patients underwent first-time VPS at the Beth Israel Deaconess Medical Center (Boston, USA) between 2004 and 2012; 40 patients had hydrocephalus from brain metastasis and 19 from primary tumors. The analyzed independent variables included demographics, body mass index, past medical history, clinical presentation, indication for surgery, Karnofsky performance status (KPS) score and surgical technique; the dependent variables were postoperative symptoms and occurrence, cause and time of shunt failure. The outcomes were analyzed with the t-test and Kaplan-Meier estimates for shunt survival. The mean age of the patients was 57.2 years and the mean operative time was 50.4 min. Symptomatic palliation was achieved in 93% of the cases; patients with severe symptoms, such as debilitating headaches, nausea and vomiting, benefited significantly from VPS. The mean follow-up time was 6.3 months; complications occurred in only 7 patients (11.8%) during follow-up: 2 in the proximal shunt (1 infection and 1 obstruction), both requiring revision, 1 infection in the distal catheter requiring shunt removal, 2 cases of intracerebral bleeding that were monitored with computed tomography scans, 1 wound infection treated with antibiotics and 1 valve complication that required temporary revision. The initial and 3-month KPS scores were 65±16.4 and 75±16.0, respectively. The mean overall shunt survival was 6.4 months (range, 1.0 day-76.0 months) from the placement of the VP shunt. At 3 months after VPS, 93.5% of the patients remained alive with functioning shunts and at 1 year 87% of the shunts were still functioning. In conclusion, VPS remains a valid option for cancer patients with low KPS, as it improves the quality of life in such patients, even in the setting of previous infection, hemorrhage, or leptomeningeal disease, since shunt patency outlasts the overall survival of nearly all patients.

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Laparoscopic versus non–laparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis

Cited by 42 publications

References 34 publications

Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial

Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial

Laparotomy versus Laparoscopic Placement of Distal Catheter in Ventriculoperitoneal Shunt Procedure

Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

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