Trocar assisted distal shunt tube insertion with intra-operative X-Ray confirmation

Trocar assisted distal shunt catheter placement could be an alternative to mini-laparotomy or laporoscopy with good results in comparison to other procedures. Objects: We report our experience with trocar assisted distal shunt tube placement with intraoperative x-ray to rule-out misplacement. Methods: Patients having peritoneal distal catheter site placement for ventriculo-peritoneal or lumbo-peritoneal shunts presenting to Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia, over 27 months' period between October 2016 and December 2018. Results: We performed 65 procedures on 58 patients with mean age of 11 years. The main etiology was congenital hydrocephalus with and without meningeocele followed by post hemorrhagic hydrocephalus and idiopathic intracranial hypertension. Two patients developed shunt infection and one case was complicated by bowel injury. No patient showed pre-peritoneal shunt tube malposition. Conclusion: Trocar-assisted distal shunt tube insertion is a good option in shunt procedures for operation time and infection risk. However, we do not recommend usage of trocar in patients with previous abdominal surgery as adhesions may increase the risk of visceral perforation.