Neuroendoscopic-assisted abdominal wall puncture technique in ventriculoperitoneal shunt surgery: implication for...

Ventriculoperitoneal shunt surgery (VPS) remains a mainstay for the treatment of hydrocephalus. This study compared the short-term efficacy and perioperative safety of a neuroendoscopic-assisted abdominal wall puncture technique for distal catheter placement with laparoscopy-assisted open laparotomy.

We conducted a single-center, non-randomized, time-sequence controlled cohort study. Patients who underwent VPS with distal catheter placement via laparoscopy-assisted open laparotomy between January 2020 and December 2021 were assigned to the Open Laparotomy Group (OLG), whereas those treated using the neuroendoscopic-assisted abdominal wall puncture approach between January 2022 and April 2025 were assigned to the Abdominal Wall Puncture Group (APG). Perioperative inflammatory markers, operative parameters, and early radiological and functional outcomes were compared between groups. Intraoperative technical difficulties, peritoneal adhesions, and complications were descriptively recorded. Safety of CO₂ pneumoperitoneum was monitored by postoperative head CT.

not applicable.

Sixty-nine patients were included (APG, n = 34; OLG, n = 35). On postoperative day 1 and day 3, white blood cell and neutrophil counts were significantly lower in the APG than in the OLG (all p < 0.05). The Evans index and Activities of Daily Living (ADL) scores were comparable between groups preoperatively and at 3 days postoperatively (all p > 0.05), while both measures improved from baseline within each group (all p < 0.05). Compared with the OLG, the APG was associated with reduced intraoperative blood loss (p = 0.023), shorter operative time (p = 0.040), and shorter postoperative length of stay (p = 0.016). No intraoperative visceral injury or catheter malposition requiring revision occurred in either group. Peritoneal adhesions were observed in 3 OLG patients and 2 APG patients, none requiring conversion. In the APG, postoperative head CT on day 1 showed no intraventricular or subdural air. The incidence of distal shunt obstruction within 3 months was low and did not differ significantly between groups (p = 0.115).

In this non-randomized, time-sequence cohort, neuroendoscopic-assisted abdominal wall puncture for distal catheter placement was associated with less perioperative blood loss, lower early postoperative inflammatory markers, and shorter operative time and hospital stay, while achieving similar early radiological and functional improvement and short-term shunt patency compared with laparoscopy-assisted open laparotomy. However, given the limited sample size, the non-randomized design, and the short (3-month) follow-up, these results support only preliminary conclusions. Longer-term follow-up (e.g., ≥ 1-2 years) is required to evaluate late complications and shunt durability, including distal obstruction, catheter migration, peritoneal adhesions, and infection.