Laparoscopically assisted peritoneal shunt insertion for hydrocephalus.
Over the past 50 years, various shunting procedures involving the peritoneum have been performed for the treatment of hydrocephalus. During placement of the peritoneal portion of the catheter, complications may arise secondary to a lack of direct visualization. We describe a reduced complication rate with laparoscopically-assisted placement of the peritoneal portion of the catheter. A retrospective chart review was performed of seventy-six (76) laparoscopically-assisted cases performed without consideration of prior abdominal surgery or obesity. Subjects ranged in age from 19 to 80 years. Mean operative time was 55.3 minutes. No visceral injuries occurred. To date, no infectious complications have occurred. In 3% of subjects, conversion to an open procedure was necessary after failure to establish pneumoperitoneum. Laparoscopic placement of peritoneal shunts is safe and efficacious. It provides visualization of the distal catheter target. Moreover, it reduces the risk of visceral complications, CSF pseudocysts, or extraperitoneal placement of the catheter. In the future, laparoscopic placement of the peritoneal portion of the catheter may become a standard treatment in those patients requiring placement of a peritoneal catheter.
Sekula
Raymond F
RF
Department of Neurosurgery, Allegheny Neuroscience Institute, Allegheny General Hospital, Drexel University, College of Medicine, Pittsburgh, Pennsylvania 15212, USA.
Marchan
Edward M
EM
Oh
Michael Y
MY
Kim
D Kyle
DK
Frederickson
Andrew M
AM
Pelz
Geoffrey
G
Uchal
Miro
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*; D055815:Young Adult