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Laparoscopic-Assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-Analysis
Sunny Abdelmageed1, Prottusha Sarkar1, Nathan A Shlobin1
1Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA.
Neurosurgery
|October 28, 2024
Summary
Laparoscopic peritoneal access for ventriculoperitoneal (VP) shunting reduces distal shunt failure, operative time, and hospital stay compared to open laparotomy. This minimally invasive approach offers improved outcomes and should be considered for shunt insertion.
Area of Science:
- Neurosurgery
- Minimally Invasive Surgery
- Medical Device Technology
Background:
- Ventriculoperitoneal (VP) shunting is the primary treatment for hydrocephalus.
- Open laparotomy is the traditional method for peritoneal access in VP shunting.
- Laparoscopic peritoneal access is an emerging minimally invasive alternative with debated efficacy.
Purpose of the Study:
- To systematically review and meta-analyze studies comparing laparoscopic versus open laparotomy for peritoneal access in VP shunting.
- To evaluate the impact of surgical approach on shunt outcomes and patient recovery.
Main Methods:
- Systematic literature search across 3 databases adhering to PRISMA guidelines.
- Inclusion of 18 studies (12 adult, 3 pediatric, 3 mixed).
- Meta-analysis comparing outcomes between laparoscopic and open laparotomy groups.
Main Results:
- Laparoscopic access showed significantly lower distal shunt failure rates (2.2% vs 6.1%).
- Reduced operative time (56.3 vs 69.4 minutes) and length of stay (LOS) (7.3 vs 9.6 days) with laparoscopic approach.
- No significant difference in proximal/total shunt failure, intraoperative complications, or infection rates. Pediatric LOS was also reduced.
Conclusions:
- Laparoscopic peritoneal access for VP shunt insertion is associated with superior outcomes, including reduced distal shunt failure and shorter hospital LOS.
- The benefits of laparoscopic access warrant consideration for VP shunt procedures.
- Further research is needed to fully elucidate benefits, particularly in pediatric populations.
