Ventriculoperitoneal shunting: Laparoscopically assisted versus conventional open surgical approaches

Nigim, Fares; Thomas, Ajith J.; Papavassiliou, Efstathios; Critchlow, Jonathan F.; Chen, Clark C.; Siracuse, Jeffrey J.; Zinn, Pascal O.; Kasper, Ekkehard M.

doi:10.4103/1793-5482.136717

Cited by 18 publications

(8 citation statements)

References 48 publications

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“…5 , 8 , 10-13 Shunt malfunction is a common complication following VP shunt placement, with studies reporting pediatric VP shunt failure rates ranging 8%-16% within the first 30 postoperative days and between 22% and 58% within the first year of placement. [25][26][27][28][29][30][31][32] Several studies have reported decreased rates of shunt malfunction following laparoscopic VP shunt placement as compared to an open approach. 20 , 24 , 33 , 34 This has been attributed to less frequent extra-peritoneal positioning of the distal VP shunt catheter and improved visualization affording optimal catheter placement.…”

Section: Discussionmentioning

confidence: 99%

Just Stick a Scope in: Laparoscopic Ventriculoperitoneal Shunt Placement in the Pediatric Reoperative Abdomen

Sykes

Sisson

Gonda

et al. 2022

Journal of Surgical Research

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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

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Section: Discussionmentioning

confidence: 99%

Just Stick a Scope in: Laparoscopic Ventriculoperitoneal Shunt Placement in the Pediatric Reoperative Abdomen

Sykes

Sisson

Gonda

et al. 2022

Journal of Surgical Research

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“…The LOS for HCP was 7.73 days. Since HCP is a result of many brain disorders and it is difficult to measure LOS for it alone, and study by Nigim et al [ 13 ] showed that mean LOS was five days for primary HCP, while Khan et al [ 14 ] showed that the mean and median duration of hospital stay for patients was 11.7 days and five days, respectively, however, most of the cases were adults and were having many comorbidities, and also HCP was secondary to other brain problems like tumors. Our study was limited as we do not know how many of the shunt cases were complicated.…”

Section: Discussionmentioning

confidence: 99%

Duration of In-hospital Stay for Elective Neurosurgical Procedures in a Tertiary Care Hospital

Khan¹,

Haqqani²,

Ullah³

et al. 2021

Cureus

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Objective: Public hospitals have fixed days with allotted time slots during which to perform neurosurgical elective cases. If emergency operations or other events preempt these scheduled time slots, the patient remains hospitalized, waiting in queue for a new time slot. We conducted this study to determine the number of days patients remained admitted waiting for elective cases in a tertiary care public hospital, which operates on fixed days.Materials and methods: This cross-sectional study was conducted in the Department of Neurosurgery Unit B, Medical Teaching Institution (MTI) -Lady Reading Hospital (LRH), Peshawar. We reviewed the admission charts and discharge slips of all patients who were admitted and underwent operations between September 2018 and August 2019. A form was made and was completed with each patients' records like age, gender, number of days spent preoperatively and postoperatively and the total duration of stay, indication for surgery (spinal, cranial, peripheral nerve), etc. Patients who had undergone elective neurosurgical procedures were included while those who had undergone emergency surgeries or had expired during the hospital stay, had been discharged or referred to other centers were excluded from the study. All the data were entered into the statistical software SPSS version 22 (IBM Corp., Armonk, NY) and were converted into tables and charts.Results: A total of 1818 patients were admitted/discharged during the study period, and of them, 823 patients were admitted for elective neurosurgical procedures. There were 601 (73.7%) males and 222 (26.3%) females with a male to female ratio of approximately 3:1. The age range was from 09 days to 72 years and was further subdivided into six groups. The procedures were broadly divided into cranial, spinal, related to hydrocephalus (HCP)-related, and miscellaneous. Cranial procedures comprised of surgeries for brain tumors, transsphenoidal operations, vascular procedures for aneurysms, and nerve decompressions, and they comprised about 29.43% (n=244) while spinal procedures accounted for 317 (36.63%) procedures, the rest were related to HCP and miscellaneous. Preoperative and postoperative stay durations were calculated and then added to determine the total stay durations and were further stratified for the specific procedures and categorized into days and weeks. About 58.26% (n=143) of cranial cases, and 156 (49.36%) of spinal cases, 37.57% (n=65) of HCP-related cases, and 36.66% (n=41) of cases in the miscellaneous group had a duration of stay between eight days to more than three weeks.

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“…[7] Nevertheless, in very complex cases, the use of an endoscopy assisted catheter placement can still be necessary to control for extensive intraabdominal adhesions that cannot be handled from extraperitoneally. [10] Given the actual rates of shunt dysfunction, and here especially abdominal dislocation, our cohort is not sufficiently large to draw conclusions based on statistical analysis. With the present series we aim to share our technique in a detailed way and demonstrate the feasibility and safety of this approach.…”

Section: Discussionmentioning

confidence: 99%

Introduction of a self-holding retractor for optimized abdominal visualization in ventriculoperitoneal shunt surgery: first experiences at a single center

2019

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OBJECTIVE: Ventriculoperitoneal shunt implantation is a common procedure in general neurosurgery. The patient population is often fragile, ranging from elderly to pediatric patients, and avoidance of perioperative complication is of utmost importance. Abdominal catheter dislocation has been found to be a common cause for early shunt dysfunction and needs to be avoided by optimal visualization of the abdominal catheter insertion zone. Here, we introduce a self-holding wound retractor system Alexis® and demonstrate its use for abdominal shunt surgery in a series of patients. METHODS: We explain the use of the Alexis® self-holding wound retractor during open ventriculoperitoneal shunt surgery in a series of 16 patients operated at our institution. RESULTS: The self-holding retractor consists of two polymer rings connected by a polymer membrane. The deep ring is easily placed on the internal fascia of the straight muscle and circular retraction is achieved by twisting the upper ring. Free hand working can then be performed by a single surgeon with good abdominal exposure. No case of abdominal dislocation or infection occurred in our series, although no properly powered statistical analysis can be performed regarding the sample size. CONCLUSION: We demonstrate the Alexis® Wound Retractor, which is an easy tool for optimal visualization of the abdominal catheter insertion zone. We believe it can facilitate surgical practice of shunt surgery, especially in obese patients.

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Ventriculoperitoneal shunting: Laparoscopically assisted versus conventional open surgical approaches

Cited by 18 publications

References 48 publications

Just Stick a Scope in: Laparoscopic Ventriculoperitoneal Shunt Placement in the Pediatric Reoperative Abdomen

Just Stick a Scope in: Laparoscopic Ventriculoperitoneal Shunt Placement in the Pediatric Reoperative Abdomen

Duration of In-hospital Stay for Elective Neurosurgical Procedures in a Tertiary Care Hospital

Introduction of a self-holding retractor for optimized abdominal visualization in ventriculoperitoneal shunt surgery: first experiences at a single center

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