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KMID : 0978820080110010025
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2008 Volume.11 No. 1 p.25 ~ p.29
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Ventriculoperitoneal Shunts: the Usefulness of Laparoscopic-assisted Distal Shunt Placement
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Sim Jin-Seok
Yoo Young-Bum
Lee Hae-Won
Chang Seong-Hwan
Kho Young-Cho
Cho Joon
Moon Chang-Taek
Yun Ik-Jin
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Abstract
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Purpose: Distal ventriculoperitoneal shunt catheter placement has traditionally been performed using a small abdominal incision. However, because this is done blindly, shunt failure frequently occurs secondary to inaccurate peritoneal catheter tip placement. Although laparoscopy has been used to facilitate peritoneal catheter placement, it is not usually the primary method. This study aimed to determine the usefulness and potential advantages of laparoscopic distal catheter placement as the primary approach through comparison with conventional minilaparotomy technique.
Methods: Between August 2005 and December 2007, 80 patients with hydrocephalus (no neonates)underwent
ventriculoperitoneal shunt placement at Konkuk University Medical Center. Forty-nine patients underwent laparoscopic
distal shunt placement during this period. The results were compared with those of another group of 31 patients who
underwent surgery by conventional approach, using retrospective analysis.
Results: No statistically significant difference in the rate of shunt faillure was noted between the two groups. Age, sex, underlying disease, preoperative infectious disease, preoperative leukocytosis, preoperative increased C-reactive
protein (CRP), and operative time proved to be insignificant risk factors for inducing shunt failure. Shunt failure was
increased principally due to shunt malfunction in patients in the mini-laparotomy group who had undergone previous
abdominal surgery. However, shunt malfunction was significantly reduced by laparoscopic distal catheter placement.
Conclusion: The advantage of the laparoscopic approach was confirmed by noting precise catheter positioning and assessing cerebrospinal fluid (CSF) flow under direct visualization. We recommend laparoscopic-assisted distal
ventriculoperitoneal shunt placement as a primary technique.
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KEYWORD
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Laparoscopy, Peritoneal distal catheter, Ventriculoperitoneal
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