Laparoscopic insertion of ventriculoperitoneal shunts in pediatric patients — A retrospective cohort study
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In brief
In brief
Retrospective comparison of 210 pediatric VPS insertions (41 laparoscopic, 169 open) found no significant difference in shunt infections, complications, or peritoneal obstruction rates between techniques, though laparoscopic procedures required longer operative time. Study suggests potential benefit for select populations including obese patients or those with prior abdominal surgery.
Written by the GCMD Library team from the article.
Introduction
Ventriculoperitoneal shunts (VPSs) are the mainstay of treatment of hydrocephalus but have frequent complications including shunt failure and infection. There has been no comparison of laparoscopic versus open primary VPS insertion in children. We hypothesized that laparoscopic VP shunt insertion may improve patient outcomes.
Methods
A prospectively-maintained, externally-validated database of pediatric patients who underwent VPS insertion at a single center between 2012 and 2016 was reviewed. Outcomes including subsequent revisions, shunt infections, operative time, and hospital stay between open and laparoscopic groups were compared.
Results
210 patients underwent VPS insertion — 41 laparoscopically and 169 open. Operative time was longer for laparoscopic insertions. There was no difference in shunt infections, complications or length of stay. There was no difference between overall revisions or in confirmed peritoneal obstructions in the laparoscopic (12%) versus open VPS insertions (5%), p = 0.13.
Conclusions
This first cohort analysis of laparoscopic versus open VPS insertion in pediatric patients indicates no difference in confirmed peritoneal obstructions. With increasing use of laparoscopic placement in some centers, it remains important to elucidate if there is a subset of pediatric patients who might benefit from this technique; possible candidates may be those who are overweight/obese or have had previous intra-abdominal surgery.
Level of evidence
III — Retrospective cohort study.