Laparoscopic Versus Open Ventriculoperitoneal Shunt Placement: A Non-inferiority Study

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Ventriculoperitoneal shunt (VPS) placement is a common neurosurgical procedure for hydrocephalus.
• Traditionally, the abdominal portion of the VPS is inserted via an open surgical approach.
• Laparoscopic techniques are emerging as an alternative for peritoneal catheter insertion.

Purpose of the Study:

• To compare the outcomes of open versus laparoscopic insertion of the peritoneal catheter for VPS.
• To evaluate differences in length of stay, blood loss, shunt failure, and complications.

Main Methods:

• Retrospective review of 104 adult patients undergoing VPS insertion between 2015 and 2017.
• Comparison of open (neurosurgical) versus laparoscopic (general surgery) peritoneal catheter placement.
• Non-inferiority analysis of patient demographics and outcomes, including length of stay (LOS), estimated blood loss (EBL), and shunt failure rates.

Main Results:

• 62 open and 42 laparoscopic cases were analyzed with similar baseline characteristics.
• Estimated blood loss (EBL) and hospital length of stay (LOS) were non-inferior in the open group compared to the laparoscopic group.
• Non-inferiority could not be demonstrated for overall or distal shunt failure rates between the two approaches.

Conclusions:

• The open approach for ventriculoperitoneal shunt insertion is non-inferior to the laparoscopic approach regarding EBL and LOS.
• Further investigation is needed to definitively compare shunt failure rates between open and laparoscopic VPS insertion.
• Neurosurgical teams can continue to utilize the traditional open method for peritoneal shunt catheter placement.