Meta-Analysis study Factors favouring Laparoscopic Over Laparotomy Technique Of Vp Shunts

Abstract

Hydrocephalus is caused by the accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain that may cause symptoms of increased intracranial pressure, neurologic deficits, and, in pediatric patients, increased cranial size. The prevalence of hydrocephalus is 1 to 1.5%. Ventriculo-peritoneal shunts (VPSs) are the mainstay of treatment for patients with hydrocephalus of diverse etiologies. Distal shunt failures, either due to improper placement or secondary dislocation of the distal catheter out of the peritoneal cavity have been reported in 10%–30% of cases of shunt failure. The way the catheter is inserted seems to play a major role in subsequent failure.

The classic laparotomy requires closing of the peritoneal entry point around the catheter, carrying the risk of catheter ligation or secondary dislocation into the subcutaneous tissue.

An alternative to laparotomy in patients undergoing VP shunt surgery is the laparoscopic placement of the peritoneal catheter, as described by Basauri and colleagues in 1993.

Aim of this work , To review, revise and redefine the role of laparoscope in the effectiveness of ventriculo-peritoneal shunt placement in a Meta-analytical form , minimizing procedurel and hospital stay together with postoperative complications in comparison to laparotomy techniques in patients with hydrocephalus and its role in revision of ventriculo-peritoneal shunts .

The current study is a systematic review and meta-analysis of studies concerning laparoscopically assisted ventriculo-peritoneal shunt placement. After using the previously mentioned selection criteria, a total of 12 studies with 3173 patients were included in the systematic review.