Distal catheter fixation in ventriculoperitoneal shunt by videolaparoscopy - Technical note

Ventriculoperitoneal shunt (VPS) is widely used in the treatment of hydrocephalus (HC), but it is frequently associated with complications such as migration and obstruction of the distal catheter, which can impact therapeutic success. Inadequate fixation of the catheter is one of the primary causes of these complications. Laparoscopic techniques involving fixation of the catheter at two points have been proposed to reduce the risk of migration and improve outcomes, although the literature still lacks consensus on the ideal technique.

An 80-year-old obese female presented with ataxia, headache, urinary incontinence, and papilledema. HC was confirmed by computed tomography. The patient underwent a right VPS using an innovative laparoscopic technique for distal catheter fixation. After the placement of the ventricular catheter and programmable valve, the distal catheter was secured with two 2-0 polypropylene sutures and two loops in the right paracolic gutter.

The patient progressed well, with no complications in the immediate postoperative period. The fixation was effective in preventing distal catheter migration and reducing obstruction. The laparoscopic approach was successful.

Laparoscopic fixation of the distal catheter with two sutures and loops is a promising technique to improve VPS outcomes, reducing complications. However, further studies are needed to confirm its long-term efficacy and safety.