Distal end revision of ventriculoperitoneal shunts sparing minilaparotomy (original) (raw)
Related papers
Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt
Turkish Neurosurgery, 2012
AIm: Evaluation of the laparoscopic assisted revision of the ventriculoperitoneal shunt as an alternative technique to the traditional laparotomy. mAterIAl and 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. COnClusIOn: Laparoscopic assisted revision of the peritoneal catheter is an alternative technique to traditional laparotomy in the revision of ventriculoperitoneal shunt.
The periumbilical approach in ventriculoperitoneal shunt placement: technique and long-term results
Journal of neurosurgery, 2013
A stAndArd surgical treatment for hydrocephalus is placement of a VP shunt. The distal VP shunt catheter is commonly inserted via a minilaparotomy. However, significant morbidity can result secondary to using a traditional laparotomy, including adhesion formation, visceral injury, postoperative hernia formation, and increased postoperative pain. 12 In addition, the minilaparotomy incision leads to cosmetically unfavorable results. Given that patients who undergo shunt placement are living longer and distal revisions are less common than proximal revisions, minimally invasive approaches to the peritoneum are preferred for cosmetic reasons and are increasingly being used. 6,18,19 Several groups have reported less invasive approaches using laparoscopy for placement of the peritoneal portion of a VP shunt. 1,9,18-20 The purported advantages of this technique are increased visualization to ensure correct placement of the distal catheter, decreased blood loss, shorter operative time, and minimal scar formation. 18,19
Surgical neurology international, 2016
Bowel perforation is a serious but rare complication after a ventriculoperitoneal shunt (VPS) procedure. Prior studies have reported spontaneous bowel perforation after VPS placement in adults of up to 0.07%. Transanal catheter protrusion is a potential presentation of VPS bowel perforation and places a patient at risk for both peritonitis and ventriculitis/meningitis via retrograde migration of bacteria. This delayed complication can be fatal if unrecognized, with a 15% risk of mortality secondary to ventriculitis, peritonitis, or sepsis. We describe a unique case of a patient with distal VPS catheter protrusion from the anus whose bowel perforation did not cause clinical sequelae of infection. We were able to manage the patient without laparotomy. A subset of patients can be managed without laparotomy and only with externalization of the ventricular shunt with antibiotics until the cerebrospinal fluid cultures finalize without growth.
Treatment approaches for abdominal migration of peritoneal catheter of ventriculoperitoneal shunt
2007
Migration of peritoneal catheter into the abdominal cavity is rare. We have discussed and presented the treatment options in two cases with accompanying literature. Abdominal migration of peritoneal catheter appears as a result of shunt fracture and disconnection. The complaints on presentation in the abdominal cavity migration of peritoneal catheter are due to shunt dysfunction and peritoneal irritation. The peritoneal catheter with abdominal migration should be removed in cases where abdominal symptoms are present. This procedure may be easily performed laparoscopically with a single mini incision. In some cases, the catheter may cause adhesions to the intra-abdominal organs. Forcefully pulled catheters may result in organ injuries. One should therefore switch to laparotomy in these cases.
Cureus
Ever since the shunt device became the gold standard treatment for hydrocephalus, complications due to infections and mechanical problems have increased while lives have been saved. In addition, abdominal complications have become an important issue as the peritoneum is now the main place to insert the distal catheter. The most common complications were abdominal pseudocyst, distal catheter migration, inguinal hernia, catheter disconnection, and intestinal obstruction. The pediatric population is more prone to develop most of these complications due to their rapidly growing body, weaker abdominal musculature, and increased intraabdominal pressure. The goal of this review was to study the main aspects associated with abdominal complications after ventriculoperitoneal shunt (VPS) insertion, including the pathophysiology, epidemiological aspects, as well as the rationale for management and prevention according to the current "state-of-the-art." It is paramount to recognize the risk factors associated with various types of complications to manage them properly.
Ventriculoperitoneal shunt complications: A review
Interdisciplinary Neurosurgery, 2018
Ventriculoperitoneal shunt (VPS) placement is one of the most commonly performed neurosurgical procedures and is necessary to treat most forms of hydrocephalus. Unfortunately, complications related to VPS placement are common, and multiple shunt revisions are almost expected throughout a patient's lifetime. Shunt malfunction may be attributed to multiple causes, including obstruction, infection, pseudocyst formation and bowel perforation. VPS obstruction, which is most often occurs in the proximal catheter, is the most common cause of VPS malfunction. Hardware infection is the second most common cause of VPS malfunction, and this is a complication is most often observed in infants, with premature infants being the most susceptible. Despite continuous attempts to reduce the incidence of VPS complications, such as improved sterile techniques, antibiotic impregnated catheters, and programmable valves, VPS malfunction remains a major problem, which often leads to multiple and costly hospital admissions. In the present review, the most common complications of VPS are discussed, including presentation and appropriate management.
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA
Background: Cerebrospinal fluid shunting is the most commonly performed surgical procedure in the management of hydrocephalus. Although frequently performed, this procedure is not free of complications. Case description: We report a case of non-described shunt migration, in which the ventricle-peritoneal catheter, at the mediastinum level, crosses to the contralateral side. Conclusion: When we are faced with complications after ventriculoperitoneal shunt surgeries, we should consider unusual or even unpredictable possibilities.