Laparoscopic-assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-analysis

Introduction: The most common treatment of hydrocephalus is ventriculoperitoneal (VPS). Traditionally the distal catheter is inserted either through open laparotomy or more recently laparoscopy. Many studies have reported the benefits of a minimally invasive approach and suggested a reduced incidence of shunt malfunction. However, there is still no official consensus on its use.

Methods: A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using three databases. Ten studies with adult populations and four studies including pediatrics populations were included

Results: 1929 patients underwent laparoscopic shunt insertion and 2732 patients underwent non-laparoscopic insertion. The laparoscopic group had a weighted mean age of 45.4 years and the non-laparoscopic group had a weighted mean age of 42.8 years. Laparoscopic access was associated with a 3.6 % reduction in distal shunt failure with 2.37% failure in the laparoscopic group compared with 5.98% in the non-laparoscopic group. Laparoscopic access was also associated with a reduction in operative time (~13 min) and length of stay (~2.3 days). There were no significant differences between the laparoscopic and non-laparoscopic groups with respect to proximal shunt failure, total shunt failure, intraoperative complications, or infection rate.

Conclusion : Laparoscopic peritoneal access during shunt insertion is associated with improved outcomes, particularly reduced distal malfunction, when compared to non-laparoscopic insertion and should be considered for shunt insertion in both adult and pediatric populations.