Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt.
OBJECTIVE
Evaluation of the laparoscopic assisted revision of the     ventriculoperitoneal shunt as an alternative technique to the traditional     laparotomy.


METHODS
Out of 1181 elective neurosurgical procedures     have been done from January 2009 to December 2010. There are 98 (8.2%)     ventriculoperitoneal shunt procedures. New shunt insertion was performed 41     times (41.9%) and shunt revision performed 57 times (58.1%). Shunt-related     infection was detected in 11 cases (11.22%) while mechanical failure was found     in 46 cases (46.9%), proximal obstruction was diagnosed in 26 cases (26.5 %)     while 20 patients (20.4%) suffered from distal obstruction. Out of the 20     patients with distal obstruction, 12 patients were treated with laparoscopic     assisted revision of the peritoneal end.


RESULTS
Intra operative finding     revealed peritoneal adhesion in 83.3% of cases and cerebrospinal fluid pseudo     cyst in 16.6% while extra peritoneal tube was found in one case. Intraoperative     management included adhesiolysis in 10 patient, evacuation and marsupialization     of the cyst in two cases in addition to tube repositioning in all cases. There     was no procedure-related complications.


CONCLUSIONS
Laparoscopic assisted     revision of the peritoneal catheter is an alternative technique to traditional     laparotomy in the revision of ventriculoperitoneal shunt.
Zagazig University, Department of Neurosurgery, Zagazig, Sharkia, Egypt. drsam1974@gmail.com
Safwat
S
Abouhashem
Mahmoud M
MM
Taha
Ashraf
A
Ismail
Magdy
M
El Rashed
D000293:Adolescent; D000328:Adult; D002648:Child; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology; D012086:Reoperation / Q000379:methods*; D000267:Tissue Adhesions / Q000175:diagnosis / Q000209:etiology; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000379:methods*; D055815:Young Adult