Preventive Stitching for Migration of a Peritoneal Catheter Into the Abdominal Wall After Ventriculoperitoneal Shunting -Technical Note-

Abstract

Fig. 1 Schematic showing the suture beside the peritoneal catheter which penetrates the peritoneum, posterior and anterior sheath of rectus abdominis muscle, and subcutaneous fat to prevent formation of dead space. AbstractMigration of the distal end of a ventriculoperitoneal shunt into the abdominal wall (epi-peritoneal layer) is a complication which is especially likely in obese patients with high intra-abdominal pressure and wide dead space around the catheter remaining after laparotomy. A preventive abdominal stitching method for this complication was developed consisting of sutures beside the catheter penetrating the peritoneum, posterior and anterior sheath of rectus abdominis muscle, and subcutaneous fat. This method was applied to more than 20 patients who underwent ventriculoperitoneal shunting. No patient experienced shunt migration. The technique is easy and safe to perform, avoids leaving a dead space around the peritoneal catheter, and prevents catheter migration.

Migration of ventriculoperitoneal shunt to urethral and rectal orifices

“…However, due to high shunt failure and revision rates of approximately 2.5 per patient, this would be impractical and significantly increase difficulty of shunt removal 21. Non-absorptive materials have been suggested,22 but given migration can occur years from insertion, this seems unlikely to be of benefit.…”

Two Episodes of Ventriculoperitoneal Shunt Migration in a Patient with Idiopathic Intracranial Hypertension

“…Unlike patients with normal body mass index (BMI), obese patients with VP shunts have a system that essentially involves shunting of CSF from one high-pressure system (intraventricular) to a second high-pressure system (intraperitoneal) [7]. During Valsalva (such as while straining to stool) intra-abdominal pressure markedly increases, and this phenomenon is more pronounced in obese patients, whose intra-abdominal pressure is higher than patients with normal BMI even at baseline [8–10]. …”

“…This pressure may also contribute to VP shunt displacement by encouraging extrusion of the shunt. Additionally, obese patients have significantly enlarged abdominal dead spaces into which the VP shunt can migrate, making shunt displacement difficult to detect [8]. One author posits that the abdominal fat pad/pannus shifting with patient activity may act as a windlass or pulley system; with upright positioning, the fat pad pulls the VP shunt caudad, and with sitting or lying, the fat pad shifts craniad, creating redundancy within the tubing and coiling it within the abdominal wall [11].…”