Laparoscopic peritoneal catheter placement: results of a new method in 111 patients.

OBJECTIVE

Although cerebrospinal fluid shunting remains one of the most common neurosurgical procedures, it is fraught with high infection, blockage, and reoperation rates. It has been estimated that the economic cost of ventriculoperitoneal shunting exceeds $1 billion annually. A new laparoscopic technique that eliminates abdominal incisions overlying shunt hardware was applied to 111 patients requiring ventriculoperitoneal shunts in an effort to decrease the morbidity associated with shunting.

METHODS

All patients who required ventriculoperitoneal shunt insertion were eligible for this surgical technique. Patient selection was based on availability of both surgical teams (general surgery and neurological surgery) at the time of surgery. Using this technique, the distal shunt catheter is tunneled directly from the head into the peritoneal cavity under laparoscopic guidance without a skin incision directly overlying the distal catheter insertion site. Patients were followed prospectively for signs and symptoms related to shunt dysfunction, shunt infection, and incision morbidity.

RESULTS

One hundred eleven patients underwent 113 laparoscopic ventriculoperitoneal shunt surgeries between February 2003 and December 2004. The average follow-up period was 21.7 months (range, 12-34 mo). Nearly half of the patients (49%) were discharged the next morning and the majority (81%) was discharged within 2 days of surgery. Overall, 15 patients experienced complications requiring reoperation (13.5%) with a 1-year shunt survival rate of 91%. One patient (0.9%) acquired a new shunt infection, whereas two patients (1.8%) developed recurrence from a previous shunt infection. There were no abdominal incision-related complications.

CONCLUSION

This simplified laparoscopic shunt placement technique, which requires no overlying abdominal incisions, can be performed quickly with high shunt survivability and low infection rates. Furthermore, the laparoscopic method has the advantage of fast recovery time, elimination of preperitoneal or misplaced catheters, and decreased abdominal incision morbidity. The procedure can be performed by either a multidisciplinary team or entirely by neurosurgeons.