title: Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial.
abstract: OBJECT In ventriculoperitoneal (VP) shunt surgery, laparoscopic assistance can be used for placement of the peritoneal catheter. Until now, the efficacy of laparoscopic shunt placement has been investigated only in retrospective and nonrandomized prospective studies, which have reported decreased distal shunt dysfunction rates in patients undergoing laparascopic placement compared with mini-laparotomy cohorts. In this randomized controlled trial the authors compared rates of shunt failure in patients who underwent laparoscopic surgery for peritoneal catheter placement with rates in patients who underwent traditional mini-laparotomy. METHODS One hundred twenty patients scheduled for VP shunt surgery were randomized to laparoscopic surgery or mini-laparotomy for insertion of the peritoneal catheter. The primary endpoint was the rate of overall shunt complication or failure within the first 12 months after surgery. Secondary endpoints were distal shunt failure, overall complication/ failure, duration of surgery and hospitalization, and morbidity. RESULTS The overall shunt complication/failure rate was 15% (9 of 60 cases) in the laparoscopic group and 18.3% (11 of 60 cases) in the mini-laparotomy group (p = 0.404). Patients in the laparoscopic group had no distal shunt failures; in contrast, 5 (8%) of 60 patients in the mini-laparotomy group experienced distal shunt failure (p = 0.029). Intraoperative complications occurred in 2 patients (both in the laparoscopic group), and abdominal pain led to catheter removal in 1 patient per group. Infections occurred in 1 patient in the laparoscopic group and 3 in the mini-laparotomy group. The mean durations of surgery and hospitalization were similar in the 2 groups. CONCLUSIONS While overall shunt failure rates were similar in the 2 groups, the use of laparoscopic shunt placement significantly reduced the rate of distal shunt failure compared with mini-laparotomy.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Philippe
authors.initials: P
authors.lastname: Schucht
authors.forename: Vanessa
authors.initials: V
authors.lastname: Banz
authors.forename: Markus
authors.initials: M
authors.lastname: Trochsler
authors.forename: Samuel
authors.initials: S
authors.lastname: Iff
authors.forename: Anna Katharina
authors.initials: AK
authors.lastname: Krähenbühl
authors.forename: Michael
authors.initials: M
authors.lastname: Reinert
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
authors.forename: Dominique
authors.initials: D
authors.lastname: Kuhlen
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
mesh_terms: D002404:Catheterization / Q000379:methods; D002408:Catheters, Indwelling; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy; D007813:Laparotomy / Q000379:methods; D008875:Middle Aged; D010529:Peritoneal Cavity; D011446:Prospective Studies; D017211:Treatment Failure; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
keywords: BMI = body mass index; NSAID = nonsteroidal anti-inflammatory drug; VP = ventriculoperitoneal; VP shunt; hydrocephalus; laparoscopy; shunt dislocation; shunt dysfunction