Comparison of laparotomic and laparoscopic techniques for implantation of the peritoneal part of the shunt in the treatment of hydrocephalus

Česká verzia

Authors: V. Vybíhal ¹ ; T. Svoboda ²; V. Procházka ² ; P. Benda ²; G. Hanoun ¹; M. Smrčka ¹; Z. Kala ²; E. Budinská ³; Š. Bohatá
Authors place of work: Neurochirurgická klinika, LF MU a FN Brno, přednosta: Prof. MUDr. Martin Smrčka, Ph. D., MBA ¹; Chirurgická klinika, LF MU a FN Brno, přednosta: Prof. MUDr. Zdeněk Kala, CSc. ²; Institut biostatistiky a analýz, PF MU Brno, ředitel: Doc. RNDr. Ladislav Dušek, Ph. D. ³; Radiologická klinika, LF MU a FN Brno, přednosta: Prof. MUDr. Vlastimil Válek, CSc. ⁴
Published in the journal: Rozhl. Chir., 2012, roč. 91, č. 6, s. 305-310.
Category: Original articles

Summary

Introduction:
Implantation of a ventriculoperitoneal shunt is a standard procedure in the treatment of hydrocephalus. Shunt malfunction can be due to various causes, such as failure of the peritoneal (distal) part of the shunt with a frequency of 5% to 47%.

Objective:
The aim of this study was to compare laparoscopic and laparotomic techniques for implantation of a ventriculoperitoneal shunt.

Material and methods:
We considered a cohort of 304 patients with hydrocephalus, acquired during a 10-year period, who underwent surgical intervention at the Neurosurgical and Surgical Clinics of the University Hospital Brno.

Results:
The 304 patients underwent a total of 392 operations, of which 67 (17.1%) were performed using a laparoscopic approach and 325 (82.9%) using a laparotomic approach. In the laparotomy group, 59 (18.2%) interventions were repeated due to complications of the peritoneal part of the shunt, while in the laparoscopy group revisions accounted for only 3 cases (4.5%).

Conclusions:
The laparoscopic technique significantly reduces the risk of complications of the peritoneal part of the shunt, and thus the overall complications associated with the implantation of the ventriculoperitoneal shunt. Laparoscopy is indicated in the case of migration of the peritoneal catheters into the abdominal cavity and is also very helpful in revisions in the case of malfunction of the peritoneal part of the shunt or in the case of previous abdominal surgery. It can explain the anatomical conditions in the abdominal cavity and it is able to treat any incidental pathology.

Key words:
ventriculoperitoneal shunt – peritoneal catheter – laparoscopy – laparotomy – hydrocephalus

Zdroje

1. Schubert F, Fijen BP, Krauss JK. Laparoscopically assisted peritoneal shunt insertion in hydrocephalus: a prospective controlled study. Surg Endosc 2005;19(12):1588–1591.

2. Pudenz RH. The surgical treatment of hydrocephalus – an historical review. Surg Neurol 1981;15(1):15–26.

3. Rodgers BM, Vries JK, Talbert JL. Laparoscopy in the diagnosis and treatment of malfunctioning ventriculoperitoneal shunts in children. J Pediatr Surg 1978;13:247–253.

4. Armbruster C, Blauensteiner J, Ammerer HP, Kriwanek S. Laparoscopically assisted implantation of ventriculoperitoneal shunts. J Laparoendosc Surg 1993;3:191–192.

5. Bausuari L, Selman JM, Lizana C. Peritoneal catheter insertion using laparoscopic guidance. Pediatr Neurosurg 1993;19: 109–110.

6. Schievink WI, Wharen RE Jr., Reimer R, Pettit PD, Seiler JC, Shine TS. Laparoscopic placement of ventriculoperitoneal shunts: preliminary report. Mayo Clinic Proceed 1993;68:1064–1066.

7. Fanelli RD, Mellinger DN, Crowell RM, Gersin KS. Laparoscopic ventriculoperitoneal shunt placement: a single-trocar technique. Surg Endosc 2000;14(7):641–643.

8. Esposito C, Colella G, Settimi A, Centonze A, Signorelli F, Ascione G, Palmieri A, Gangemi M. One-trocar laparoscopy: a valid procedure to treat abdominal complications in children with peritoneal shunt for hydrocephalus. Surg Endosc 2003;17(5): 828–830.

9. Reardon PR, Scarborough TK, Matthews BD, Marti JL, Preciado A. Laparoscopically assisted ventriculoperitoneal shunt placement using 2-mm instrumentation. Surg Endosc 2000;14(6): 585–586.

10. Matushita H, Cardeal D, Pinto FC, Plese JP, de Miranda JS. The ventriculoomental bursa shunt. Childs Nerv Syst 2008;24(8): 949–953.

11. Rengachary SS. Transdiaphragmatic ventriculoperitoneal shunting: technical case report. Neurosurgery 1997;41(3):695–697.

12. Williams PL, Warwick R, Dyson M. The peritoneum. In: Williams PL, Dyson M (Eds.) Gray’s anatomy. Churchill Livingstone 1989:1336–1347.

13. Tubbs RS, Wellons JC 3rd, Blount JP, Grabb PA, Oakes WJ. Referred shoulder pain from ventriculoperitoneal shunts. Report of three cases. J Neurosurg 2005;102(2 Suppl):218–220.

14. Josephs LG, Este-McDonald JR, Birkett DH, Hirsch EF. Diagnostic laparoscopy increases intracranial pressure. J Trauma 1994;36(6):815–818.

15. Rosenthal RJ, Hiatt JR, Phillips EH, Hewitt W, Demetriou AA, Grode M. Intracranial pressure. Effects of pneumoperitoneum in a large-animal model. Surg Endosc 1997; 11(4):376–380.

16. Neale ML, Falk GL. In vitro assessment of back pressure on ventriculoperitoneal shunt valves. Is laparoscopy safe? Surg Endosc 1999;13(5):512–515.

17. Ravaoherisoa J, Meyer P, Afriat R, Meyer Y, Sauvanet E, Tricot A, Carli P. Laparoscopic surgery in a patient with ventriculoperitoneal shunt: monitoring of shunt function with transcranial Doppler. Br J Anaesth 2004;92(3):434–437.

18. Cooke SJ, Paterson-Brown S. Association between laparoscopic abdominal surgery and postoperative symptoms of raised intracranial pressure. Surg Endosc 2001;15(7): 723–725.

19. Uzzo RG, Bilsky M, Mininberg DT, Poppas DP. Laparoscopic surgery in children with ventriculoperitoneal shunts: effect of pneumoperitoneum on intracranial pressure – preliminary experience. Urology 1997;49(5):753–757.

20. Roth J, Sagie B, Szold A, Elran H. Laparoscopic versus non-laparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis. Surg Neurol 2007;68(2):177–184.

21. Barmparas G, Branco BC, Schnüriger B, Lam L, Inaba K, Demetriades D. The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg 2010; 14(10):1619–1628.

22. Vilos GA, Ternamian A, Dempster J, Laberge PY. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet Gynaecol Can 2007;29(5):433–465.

23. Popa F, Grigorean VT, Onose G, Popescu M, Strambu V, Sandu AM. Laparoscopic treatment of abdominal complications following ventriculoperitoneal shunt. J Med Life 2009;2(4):426–436.

24. Baskin JJ, Vishteh AG, Wesche DE, Rekate HL, Carrion CA. Ventriculoperitoneal shunt failure as a complication of laparoscopic surgery. JSLS 1998;2(2):177–180.

25. Schwed DA, Edoga JK, McDonnell TE. Ventilatory impairment during laparoscopic cholecystectomy in a patient with a ventriculoperitoneal shunt. J Laparoendosc Surg 1992;2(1):57–59.

26. Sane SS, Towbin A, Bergey EA, Kaye RD, Fitz CR, Albright L, Towbin RB. Percutaneous gastrostomy tube placement in patients with ventriculoperitoneal shunts. Pediatr Radiol 1998; 28(7):521–523.

27. Vinchon M, Lemaitre MP, Vallée L, Dhellemmes P. Late shunt infection: incidence, pathogenesis, and therapeutic implications. Neuropediatrics 2002;33(4):169–173.

28. Pumberger W, Löbl M, Geissler W. Appendicitis in children with a ventriculoperitoneal shunt. Pediatr Neurosurg 1998;28(1): 21–26.