Laparoscopic Peritoneal Access in Cerebrospinal Fluid Shunt Placement: Systematic Review and Meta-analysis

Introduction: Distal shunt catheters are commonly placed within the peritoneum. While this is most often performed through open laparotomy, laparoscopic techniques have been reported more recently. These minimally invasive techniques have been associated with reduced incidence of distal shunt malfunction. We sought to compare the outcomes of laparoscopic versus open distal catheter insertion through a systematic review and meta-analysis of previously-published studies.

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

Results: 1929 patients underwent laparoscopic shunt insertion and 2732 patients underwent non-laparoscopic insertion. Laparoscopic access was associated with a reduction in distal shunt failure compared to the open laparotomy (2.37% vs 5.98%, p< 0.05). Similarly, laparoscopic access was associated with a reduced operative time (p < 0.05) and reduced hospital length of stay (p < 0.05). There were no significant differences between the laparoscopic and laparotomy groups with respect to proximal shunt failure, total shunt failure, intraoperative complications, or infection rate.

Conclusion : In this meta-analysis of 17 studies comparing laparoscopic distal catheter insertion to laparotomy, laparoscopic peritoneal access was associated with reduced distal shunt malfunction, reduced operative time, and reduced hospital lengths of stay as compared to laparotomy.