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Ventriculoperitoneal shunting: Laparoscopically assisted versus conventional open surgical approaches.

Nigim F, Thomas AJ, Papavassiliou E, Schneider BE, Critchlow JF, Chen CC, Siracuse JJ, Zinn PO, Kasper EM - Asian J Neurosurg (2014)

Bottom Line: Length of stay was similar, 5 days in the laparoscopic and in the open group, (P = 0.945).Kaplan-Meier analysis demonstrated no difference in shunt survival between the two groups (P = 0.868), with functionality in 85% at 6-months and 78.5% at 1-year.According to our study, LVPS-placement results compare similarly to OVPS placement in most aspects.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

ABSTRACT

Objectives: Ventriculoperitoneal shunting (VPS) is a mainstay of hydrocephalus therapy, but carries a significant risk of device malfunctioning. This study aims to compare the outcomes of laparoscopic ventriculoperitoneal shunting versus open ventriculoperitoneal shunting (OVPS) VPS-placement and reviews our findings in the pertinent context of the literature from 1993 to 2012.

Materials and methods: Between 2003 and 2012, a total of 232 patients underwent first time VPS placement at Beth Israel Deaconess Medical Center. Of those, 155 were laparoscopically guided and 77 were done conventionally. We analyzed independent variables (age, gender, medical history, clinical presentation, indication for surgery and surgical technique) and dependent variables (operative time, post-operative complications, length of stay in the hospital) and occurrence of shunt failure.

Results: Mean operative time was 43.7 min (18.0-102.0) in the laparoscopic group versus 63.0 min (30.0-151.0) in the open group, (P < 0.05). Length of stay was similar, 5 days in the laparoscopic and in the open group, (P = 0.945). The incidence of shunt failure during the entire follow-up period was not statistically different between the two groups, occurring in 14.1% in the laparoscopic group and 16.9% in the open group, (P = 0.601). Kaplan-Meier analysis demonstrated no difference in shunt survival between the two groups (P = 0.868), with functionality in 85% at 6-months and 78.5% at 1-year.

Conclusion: According to our study, LVPS-placement results compare similarly to OVPS placement in most aspects. Since laparoscopic placement is not routinely indicated, we suggest a prospective study to assess its value as an alternate technique especially suitable in obese patients and patients with previous abdominal operations.

No MeSH data available.


Related in: MedlinePlus

Number of shunt failure distributed per period
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Figure 1: Number of shunt failure distributed per period

Mentions: Shunt failure was defined as any return of the patient to the hospital with symptoms related to shunt failure-requiring surgery. Causes of shunt failure have been categorized in proximal (infection, malposition and obstruction), distal (infection, malposition and obstruction), valve revision and over-drainage. The overall number of shunt failures in all VPS patients of this cohort was 35 (15.0%) and of those 18 (51.4%) shunts failed in the first 3 months of the follow-up period [Figure 1]. The most frequent cause was shunt infection (proximal or distal), followed by proximal and distal catheter malfunction and finally valve malfunction [Figure 2]. There was no statistically significant difference between the open and the laparoscopic group in term of shunt failure rate, (n = 13/or 16.9% vs. n = 22/or 14.1%, P = 0.601) [Table 2].


Ventriculoperitoneal shunting: Laparoscopically assisted versus conventional open surgical approaches.

Nigim F, Thomas AJ, Papavassiliou E, Schneider BE, Critchlow JF, Chen CC, Siracuse JJ, Zinn PO, Kasper EM - Asian J Neurosurg (2014)

Number of shunt failure distributed per period
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129581&req=5

Figure 1: Number of shunt failure distributed per period
Mentions: Shunt failure was defined as any return of the patient to the hospital with symptoms related to shunt failure-requiring surgery. Causes of shunt failure have been categorized in proximal (infection, malposition and obstruction), distal (infection, malposition and obstruction), valve revision and over-drainage. The overall number of shunt failures in all VPS patients of this cohort was 35 (15.0%) and of those 18 (51.4%) shunts failed in the first 3 months of the follow-up period [Figure 1]. The most frequent cause was shunt infection (proximal or distal), followed by proximal and distal catheter malfunction and finally valve malfunction [Figure 2]. There was no statistically significant difference between the open and the laparoscopic group in term of shunt failure rate, (n = 13/or 16.9% vs. n = 22/or 14.1%, P = 0.601) [Table 2].

Bottom Line: Length of stay was similar, 5 days in the laparoscopic and in the open group, (P = 0.945).Kaplan-Meier analysis demonstrated no difference in shunt survival between the two groups (P = 0.868), with functionality in 85% at 6-months and 78.5% at 1-year.According to our study, LVPS-placement results compare similarly to OVPS placement in most aspects.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

ABSTRACT

Objectives: Ventriculoperitoneal shunting (VPS) is a mainstay of hydrocephalus therapy, but carries a significant risk of device malfunctioning. This study aims to compare the outcomes of laparoscopic ventriculoperitoneal shunting versus open ventriculoperitoneal shunting (OVPS) VPS-placement and reviews our findings in the pertinent context of the literature from 1993 to 2012.

Materials and methods: Between 2003 and 2012, a total of 232 patients underwent first time VPS placement at Beth Israel Deaconess Medical Center. Of those, 155 were laparoscopically guided and 77 were done conventionally. We analyzed independent variables (age, gender, medical history, clinical presentation, indication for surgery and surgical technique) and dependent variables (operative time, post-operative complications, length of stay in the hospital) and occurrence of shunt failure.

Results: Mean operative time was 43.7 min (18.0-102.0) in the laparoscopic group versus 63.0 min (30.0-151.0) in the open group, (P < 0.05). Length of stay was similar, 5 days in the laparoscopic and in the open group, (P = 0.945). The incidence of shunt failure during the entire follow-up period was not statistically different between the two groups, occurring in 14.1% in the laparoscopic group and 16.9% in the open group, (P = 0.601). Kaplan-Meier analysis demonstrated no difference in shunt survival between the two groups (P = 0.868), with functionality in 85% at 6-months and 78.5% at 1-year.

Conclusion: According to our study, LVPS-placement results compare similarly to OVPS placement in most aspects. Since laparoscopic placement is not routinely indicated, we suggest a prospective study to assess its value as an alternate technique especially suitable in obese patients and patients with previous abdominal operations.

No MeSH data available.


Related in: MedlinePlus