Peritoneal insertion of shunts in children: comparison between trocar and laparoscopically guided insertion

Serafimova, Marga; Soleman, Jehuda; Stoessel, Tabea; Guzman, Raphaël; Constantini, Shlomi; Roth, Jonathan

doi:10.1007/s00381-020-04760-x

Cited by 8 publications

(11 citation statements)

References 41 publications

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“…There is only one comparative study, published by our group, comparing trocar-assisted to laparoscopic distal VPS placement. Trocar-assisted placement had a non-statistically significantly higher rate of distal malfunction and distal complications compared with laparoscopic-guided shunt placement [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…These studies showed that laparoscopic VPS placement is safe in children and a possible alternative to the traditional mini-laparotomy and suggest an improvement in outcome [1,9,10,[19][20][21][22][23]. Laparoscopy has been shown to have very low failure rates, with some studies reporting no distal failure [21,24]. However, some studies such as the study by Yu et al [9] also included a pre-selected subset of pediatric patients with previous shunt malfunctions undergoing revision surgery.…”

Section: Distal Placementmentioning

confidence: 99%

“…Distal shunt failure rates make up to approximately 30% of all shunt revisions [9,10]. Traditionally, the distal end of the catheter is placed intraperitoneally via a mini-laparotomy or trocar insertion; however, several studies, most of them conducted in adults, have shown that laparoscopic placement of the distal catheter leads to fewer complications and lower shunt misplacement rates compared to traditional, open placement [11][12][13][14][15]. While there is high-quality evidence for laparoscopic shunt placement in adults, data is scarce in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

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Distal shunt placement in pediatric ventriculoperitoneal shunt surgery: an international survey of practice

et al. 2023

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Objective Ventriculoperitoneal shunt (VPS) surgery is a common treatment for hydrocephalus in children and adults, making it one of the most common procedures in neurosurgery. Children being treated with a VPS often require several revisions during their lifetime with a lifetime revision rate of up to 80%. Several different techniques exist for inserting the distal catheter, while mini-laparotomy, trocar, or laparoscopy is traditionally used. As opposed to adults, only few studies exist, comparing the outcome of the different distal catheter placement techniques in children. This international survey aims to investigate the current daily practice concerning distal shunt placement techniques in children. Material and methods An online questionnaire investigating the different techniques used to place the distal catheter in pediatric VPS surgery was distributed internationally. All results were analyzed using descriptive and comparative statistics. Results A total of 139 responses were obtained. Mini-laparotomy was reported to be the most frequently used technique (n = 104, 74.8%) for distal shunt placement in children, while laparoscopic or trocar-assisted placements were only used by 3.6% (n = 5) and 21.6% (n = 30) of all respondents, respectively. Over half (n = 75, 54.0%) of all respondents do not believe that laparoscopic placement improves the outcome. Conclusion This international survey shows that mini-laparotomy is the most frequently used technique for distal VPS placement in children all over the world. Further randomized trials are needed to elucidate this matter.

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Section: Discussionmentioning

confidence: 99%

Section: Distal Placementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distal shunt placement in pediatric ventriculoperitoneal shunt surgery: an international survey of practice

et al. 2023

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“…Studies have previously shown the benefits of a laparoscopic-assisted approach including decreased surgical time, reduced risk of ileus, ease of access in obese patients, and decreased risk of adhesions [ 2 , 4 , 11 , 12 ]. Detractors of laparoscopic-assisted ventriculoperitoneal shunt placement cite the increased risk of infection, increased operative time, and difficulty in coordinating care all presumably due to the presence of an additional surgical team [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Co-surgeon Ventriculoperitoneal Shunt Placement Versus Single Surgeon Mini Laparotomy

Mulvaney¹,

Arnold²,

Reinke³

et al. 2022

Cureus

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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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“…To avoid complications in obese patients, placing the peritoneal catheter beneath the abdominal fat pad just over the rectus abdominis muscle and closing the peritoneum has been recommended 8. Laparoscopic-assisted shunt placement has been associated with fewer distal shunt failures 13–17. Its use ensures adequate placement of the distal catheter inside the peritoneal cavity under direct vision 14 15 18.…”

Section: Discussionmentioning

confidence: 99%

Huge subcutaneous extraperitoneal pseudocyst after migration of the ventriculoperitoneal shunt catheter

et al. 2021

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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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Peritoneal insertion of shunts in children: comparison between trocar and laparoscopically guided insertion

Cited by 8 publications

References 41 publications

Distal shunt placement in pediatric ventriculoperitoneal shunt surgery: an international survey of practice

Distal shunt placement in pediatric ventriculoperitoneal shunt surgery: an international survey of practice

Laparoscopic Co-surgeon Ventriculoperitoneal Shunt Placement Versus Single Surgeon Mini Laparotomy

Huge subcutaneous extraperitoneal pseudocyst after migration of the ventriculoperitoneal shunt catheter

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