Comparative Study Between Laparoscopic and Open Techniques for Insertion of Ventriculperitoneal Shunt for Treatment of Congenital Hydrocephalus.

INTRODUCTION: Different methods and devices have been developed to regulate cerebrospinal fluid flow for the treatment of congenital hydrocephalus (HC). In addition, progress in shape and materials of catheters and also valves has been achieved. Although many studies in literature have evaluated the benefits of a laparoscopic approach, few researches have compared the two techniques used for the insertion of the ventriculoperitoneal shunt (VPS).

AIM: The aim of this study was to compare laparoscopically assisted VPS (LVPS) with open VPS and to evaluate the benefits of LVPS.

PATIENTS AND METHODS: This cross-sectional analytic study was conducted on 192 children undergoing either laparoscopic or open placement of VPSs for congenital HC over 1-year period. Insertion of the proximal tube and reservoir were performed and the distal tube was then passed into the peritoneal cavity, either conventionally or laparoscopically assisted.

RESULTS: Mean operative time was 50.1 minutes (28.0-121.8 minutes) in the laparoscopic group versus 74.0 minutes (39.0-162.0 minutes) in the open group (P < .05). Duration of hospital stay was the same (P = .938). The percentage of shunt failure during the follow-up period was 10% in the laparoscopic group and 17% in the open group (P = .623). Shunts were working in 85% at 6 months and 78.5% at 1 year.

CONCLUSION: The laparoscopically assisted placement of VPS in children is safe, effective, associated with lower rates of abdominal malposition of the distal catheter, and a technically easy approach. It is an alternative method that may improve and simplify the safety of VPS surgery.