Endoscopic implantation and patency evaluation of lumboperitoneal shunt: an innovative technique.
BACKGROUND
The placement of the lumboperitoneal (LP) shunt tube used in the management of idiopathic intracranial hypertension (IIH) and the evaluation of its patency necessitate an abdominal surgical incision. This procedure can now be done using a laparoscopic-assisted technique. This study was designed to evaluate the usefulness of this technique in treating patients with IIH in whom visual loss was progressive in spite of aggressive medical management, as well as for the evaluation of the function of the shunt tube after its placement.


METHODS
Seventeen patients aged between 21 and 45 years (mean, 31) were included in the study. They were divided into two groups. Laparoscopy was used in the first group of 11 patients for primary placement of the peritoneal portion of shunt catheter in the right subphrenic recess. It was used in the second group, which consisted of six patients who had recurrence of symptoms after surgical LP shunt placement, for the evaluation of shunt patency and position inside the peritoneal cavity and for the repositioning of the displaced shunt, as needed.


RESULTS
In the first group (n = 11), visual symptomatology was improved in 10 of 11 patients and became stable in the remaining one. In the second group (n = 6), two of six patients had a patent tube in a proper position; three had complete intraperitoneal migration of the shunt tubes, which were repositioned using a laparoscopic-assisted technique; and the last patient had occlusion of the peritoneal side of the shunt by omental adhesions that had been liberated by the laparoscopy. No complications related to laparoscopy were recorded in this series.


CONCLUSIONS
This procedure was associated with better functional results, less postoperative pain and discomfort, a shorter hospital stay, an earlier return to normal activities, and cosmetic acceptability .
Hay
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SA
Department of General Surgery, Faculty of Medicine, Ain Shams University, 1 El Mokades El Kabary Street, 7th District, Nasr City, Cairo, Egypt. samehhay@hotmail.com
Hay
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AA
Moharram
H
H
Salama
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M
D000328:Adult; D002557:Cerebrospinal Fluid Shunts; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications / Q000601:surgery*; D010535:Laparoscopy; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010529:Peritoneal Cavity; D013346:Subarachnoid Space; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology