Laparoscopic-assisted ventriculoperitoneal shunt placement and reduction in operative time and total hospital charges.

OBJECTIVE: In ventriculoperitoneal shunt (VPS) placement, distal placement of the peritoneal catheter is typically performed by a neurosurgeon. More recently, laparoscopic-assisted (LA) placement of the distal peritoneal catheter by general surgeons has become common. This study examined whether LA placement of VPS (LAVPS) is associated with reduced operative time, lower hospital cost, and fewer distal revisions.

METHODS: A retrospective review was performed for all patients who received a new VPS at our institution between 2013 and 2016. Age, sex, diagnosis, previous abdominal surgeries, operative time, anesthesia grade, 30-day shunt failures, and total hospital charges were analyzed.

RESULTS: Six hundred and eighty patients underwent first-time VPS placement, including 199 with LAVPS and 481 with non-LA VPS placement (non-LAVPS). The mean age of LAVPS patients was significantly higher than that of non-LAVPS patients (64.1 vs. 59.3 years; P=.002). Mean operative time was shorter in the LAVPS group than in the non-LAVPS group (55 vs. 75 minutes; P<.001). Distal shunt revision within 30 days occurred more often among non-LAVPS patients (6 of 481 [1.2%]) than among LAVPS patients (0 of 199 [0%]). A subset analysis of patients with normal pressure hydrocephalus found decreased total hospital charges in the LAVPS group ($67,124 vs. $80,890; P=.009).

CONCLUSIONS: Compared with non-LAVPS, LAVPS is associated with significantly shorter operative times and fewer distal shunt revisions within 30 days. Subset analysis supports a decrease in total hospital charges. Additional studies are needed, but these data suggest that LAVPS is a safer, less expensive alternative to non-LAVPS.