Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial (original) (raw)
Safety of Laparoscopy in Patients with Ventriculoperitoneal Shunts
Iberoamerican journal of medicine, 2021
The relationship between the intra-abdominal pressure (IAP) and intracranial pressure (ICP) has been suspected for more than 100 years and was subsequently confirmed by numerous studies in both animals and humans which demonstrate the link and the positive correlation between IAP and ICP. There are mounting concerns that the pneumoperitoneum created during laparoscopic surgery to create space for instrument placement and to allow safe tissue dissection may result in an increase in the ICP secondary to the increase in the IAP which may result in serious consequences in patients with Ventriculoperitoneal (VP) shunts. There is uncertainty about the safety of laparoscopic surgery in VP shunt patients. The aim of this article is to review the literature to answer the question [Is laparoscopic surgery safe in VP shunt patients with and without intraoperative monitoring of ICP]?
Neurosurgical Review, 2011
This article describes the procedure of ventriculo-peritoneal shunt implantation in an English bulldog with laparoscopy-assisted placement of the peritoneal catheter in the abdominal cavity. Prior to surgery, the patient was subjected to physical and neurological examinations involving a complete blood count (CBC), biochemistry profiling, EEG and MRI. This case report also describes the patient's pharmacological treatment before the procedure, the applied surgical technique and the benefits of the laparoscopy-assisted approach.
World Journal of Laparoscopic Surgery with DVD, 2020
Background: In patients presenting pelvic pathology and a placed ventriculoperitoneal (VP) shunt, there is uncertainty regarding the decision whether to use laparoscopy. The aim of the article is to examine the available literature as well as sharing our own experiences operating on a patient with a VP shunt using laparoscopy. Materials and methods: We searched online libraries (PubMed, EMBASE, and Google Scholar) for all publications published between January 1975 and December 2018 on our topic. We performed a systematic review and shared our experience with laparoscopy in a patient with shunt and ovarian cancer. Results: The age of the patients ranged from 1 to 79 years. The operations were performed by the departments of general surgery, gynecology, and urology. The time from the shunt operation to laparoscopy ranged from 5 days to 28 years. In different articles, four important points were considered and discussed: the risk of a shunt infection or complication, technical difficulties carrying out laparoscopy in patients with a VP shunt, the necessity of routine monitoring of the intracranial pressure (ICP) intraoperatively, and perioperative strategies to avoid complications. Conclusion: It seems that a laparoscopic surgery in adults with a VP shunt appears to be a safe option. Based on the results of our case and the review of literature, we consider it necessary to have a neurosurgical consult performed prior to surgery, to have the procedure be carried out by an experienced surgeon, and to avoid complications by implementing recommended precautions.
Laparoscopic Ventriculoperitoneal Shunts: Benefits to Resident Training and Patient Safety
JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2011
Background and Objectives: Symptomatic hydrocephalus is a surprisingly common clinical condition. Neurosurgeons are expert at ventriculostomy, but minimally invasive peritoneal access is outside the realm of their current training. We have adopted a multidisciplinary approach, with general surgeons positioning the distal shunt. Our objective was to review this recent experience. Methods: All distal shunts were placed by a single surgeon with resident assistance. After ventriculostomy, the shunt tubing was tunneled onto the anterior abdominal wall. A Veress needle was placed through the tunnel incision and the abdomen insufflated. A 5-mm optical access trocar and camera were introduced via a separate stab incision. The shunt tubing was then directed into the abdominal cavity using a Hickman introducer kit, with flow confirmed visually. Results: Study patients who had between 0 and 10 previous abdominal operations received 111 consecutive shunts. There was one intraoperative complication, a colon injury during trocar placement. In this case, the colotomy was repaired and the shunt placed in the pleural space. There were no conversions to the open abdominal approach. Postoperatively, there were no wound infections, no cases of shunt malpositioning, and there were no deaths. Conclusions: Laparoscopic placement of ventriculoperitoneal shunts is feasible, safe, and carries a low rate of complications. The value to resident education in the practice of this procedure has not been previously emphasized. In the era of increased awareness of patient safety, laparoscopic VP shunting serves as a model for accomplishing both goals of improved outcomes and quality surgical education.
Laparoscopic treatment of abdominal complications following ventriculoperitoneal shunt
Journal of medicine and life
The aim of this study is the evaluation of laparoscopic treatment in abdominal complications following ventriculoperitoneal (VP) shunt. We report a retrospective study including 17 patients with abdominal complications secondary to VP shunt for hydrocephalus, laparoscopically treated in our department, between 2000 and 2007. Patients' age ranged from 1 to 72 years old (mean age 25.8 years old). Male: female ratio was 1.4. Abdominal complications encountered were: shunt disconnection with intraperitoneal distal catheter migration 47.05% (8/17), infections 23.52% (4/17) such as abscesses and peritonitis, pseudocysts 11.76% (2/17), CSF ascites 5.88% (1/17), inguinal hernia 5.88% (1/17), and shunt malfunction due to excessive length of intraperitoneal tube 5.88% (1/17). Free-disease interval varies from 1 day to 21 years, depending on the type of complication, short in peritoneal irritation syndrome and abscesses (days) and long in ascites, pseudocysts (months-years). Laparoscopic t...
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.
Asian Journal of Neurosurgery, 2014
Objectives: Ventriculoperitoneal shunting (VPS) is a mainstay of hydrocephalus therapy, but carries a significant risk of device malfunctioning. This study aims to compare the outcomes of laparoscopic ventriculoperitoneal shunting versus open ventriculoperitoneal shunting (OVPS) VPS-placement and reviews our findings in the pertinent context of the literature from 1993 to 2012. Materials and Methods: Between 2003 and 2012, a total of 232 patients underwent first time VPS placement at Beth Israel Deaconess Medical Center. Of those, 155 were laparoscopically guided and 77 were done conventionally. We analyzed independent variables (age, gender, medical history, clinical presentation, indication for surgery and surgical technique) and dependent variables (operative time, post-operative complications, length of stay in the hospital) and occurrence of shunt failure. Results: Mean operative time was 43.7 min (18.0-102.0) in the laparoscopic group versus 63.0 min (30.0-151.0) in the open g...
Endoscopic implantation and patency evaluation of lumboperitoneal shunt: an innovative technique
Surgical Endoscopy and Other Interventional Techniques, 2004
Background: The placement of the lumboperitoneal (LP) shunt tube used in the management of idiopathic intracranial hypertension (IIH) and the evaluation of its patency necessitate an abdominal surgical incision. This procedure can now be done using a laparoscopic-assisted technique. This study was designed to evaluate the usefulness of this technique in treating patients with IIH in whom visual loss was progressive in spite of aggressive medical management, as well as for the evaluation of the function of the shunt tube after its placement. Methods: Seventeen patients aged between 21 and 45 years (mean, 31) were included in the study. They were divided into two groups. Laparoscopy was used in the first group of 11 patients for primary placement of the peritoneal portion of shunt catheter in the right subphrenic recess. It was used in the second group, which consisted of six patients who had recurrence of symptoms after surgical LP shunt placement, for the evaluation of shunt patency and position inside the peritoneal cavity and for the repositioning of the displaced shunt, as needed. Results: In the first group (n = 11), visual symptomatology was improved in 10 of 11 patients and became stable in the remaining one. In the second group (n = 6), two of six patients had a patent tube in a proper position; three had complete intraperitoneal migration of the shunt tubes, which were repositioned using a laparoscopic-assisted technique; and the last patient had occlusion of the peritoneal side of the shunt by omental adhesions that had been liberated by the laparoscopy. No complications related to laparoscopy were recorded in this series. Conclusion: This procedure was associated with better functional results, less postoperative pain and discomfort, a shorter hospital stay, an earlier return to normal activities, and cosmetic acceptability .
Ventriculoperitoneal shunt failure as a complication of laparoscopic surgery
1998
Objective: The authors report the first documented case of laparoscopically induced Ventriculoperitoneal (VP) shunt failure. Summary Background Data: Laparoscopic surgery has become a preferred method of accessing and treating a variety of intraperitoneal pathology. Surgeons can expect to encounter patients who have previously undergone placement of cerebrospinal fluid (CSF) shunts who present as candidates for laparoscopic procedures. Currently, the presence of a CSF shunt is not considered to be a contraindication to laparoscopy. We report the first documented case of laparoscopically induced VP shunt failure. Clinical History: A patient with shunt-dependent hydrocephalus underwent laparoscopic placement of a feeding jejunostomy. Postoperatively, clinical and radiographic evidence of shunt failure was noted. The patient underwent emergent shunt revision. Intraoperatively, an isolated distal shunt obstruction was encountered. Gentle irrigation cleared the occlusion. We believe that this shunt dysfunction was secondary to impaction of either soft tissue or air within the distal catheter as a consequence of peritoneal insufflation. Conclusions: It is concluded that laparoscopic surgery may represent a potential danger in patients with preexisting CSF shunts. The risk of neurological injury faced by this patient population during laparoscopy is derived from peritoneal insufflation and relates to two primary concerns. The first is impaired CSF drainage due to a sustained elevated distal pressure gradient or, as in our case, an acute distal catheter obstruction. The second concern relates to the potential for retrograde insufflation of the CSF spaces through an incompetent shunt valve mechanism. Distal shunt catheter externalization performed in conjunction with a neurosurgeon during the laparoscopic