Peritoneal insertion of shunts in children: comparison between trocar and laparoscopically guided insertion
- 26 June 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Child's Nervous System
- Vol. 37 (1), 115-123
- https://doi.org/10.1007/s00381-020-04760-x
Abstract
Purpose Ventriculo-peritoneal shunts are commonly used for treating hydrocephalus for all age groups. There are 3 main methods for shunt placement into the peritoneum: mini laparotomy, laparoscopically guided, or percutaneously with a trocar. There is limited literature comparing between these techniques in the pediatric population, and specifically—the trocar has not been compared with laparoscopy. The goal of this study is to compare trocar and laparoscopy use, with respect to safety and potential need for future shunt revisions. Methods Data was retrospectively collected from 2 centers for children (< 18 years old) who underwent a primary insertion of a CSF shunt to the peritoneum, and had no prior abdominal surgery or significant abdominal disease. One center used a trocar, and the other laparoscopic guidance. Demographics, surgical time, and shunt complications were analyzed. Primary endpoint was distal shunt malfunction, either technique-related or non-technique-related. Results Two hundred fifty-seven children (220 trocar, 37 laparoscopy) were included. The groups were similar with regard to age at surgery and etiology of hydrocephalus. Trocar use was associated with a slightly higher, although statistically insignificant, rate of technique-related distal complications (4.1% vs 0, p = 0.37). Following propensity score matching, there was no statistically significant difference in any shunt complication between both groups. Trocar use was associated with shorter surgery, and less surgical personnel. Conclusions In primary shunt surgery in children, abdominal placement of the catheter using a trocar or laparoscopic guidance is safe, and associated with a low distal malfunction rate, with no statistically significant differences between both techniques.This publication has 40 references indexed in Scilit:
- Laparoscopic insertion of the peritoneal catheter in ventriculoperitoneal shunting. Review of 405 consecutive casesInternational Journal of Surgery, 2016
- Surgical outcome of the shunt: 15-year experience in a single institutionChild's Nervous System, 2016
- Hydrocephalus in childrenThe Lancet, 2015
- Single-Incision Laparoscopic Surgery (SILS) for Ventriculoperitoneal Shunt PlacementJournal of Neurological Surgery Part A: Central European Neurosurgery, 2013
- The economic impact of ventriculoperitoneal shunt failureJournal of Neurosurgery: Pediatrics, 2011
- Laparoscopic Ventriculoperitoneal Shunts: Benefits to Resident Training and Patient SafetyJSLS : Journal of the Society of Laparoendoscopic Surgeons, 2011
- Laparotomy versus Laparoscopic Placement of Distal Catheter in Ventriculoperitoneal Shunt ProcedureJournal of Korean Neurosurgical Society, 2010
- Laparoscopic versus open approach for implantation of the peritoneal catheter during ventriculoperitoneal shunt placementSurgical Endoscopy, 2008
- Laparoscopic placement of distal ventriculoperitoneal shunt cathetersJournal of Neurosurgery: Pediatrics, 2008
- Quality of life in children with hydrocephalus: results from the Hospital for Sick Children, TorontoJournal of Neurosurgery: Pediatrics, 2007