Martin et al. [4]
Buhligen et al. [15]
Handler et al. [16]
Total n
17
29
126
Significant adhesions at initial placement
13
a
a
Failed due to adhesions
7
2
4
VA shunt
a
1
1
V pleural shunt
a
a
2
Laparotomy
a
1
1
Failed peritoneal placement
4
1
3
Complications
The complications of primary or redo VPS insertion are the same as those discussed under indications for surgery for complications of VPS. Those patients who require shunt revisions have a history of progressive difficulties reaching the abdominal cavity, intra-abdominal adhesions, CSF pseudocyst formation, and difficulty retrieving dislocated catheters [20]. Laparoscopic techniques have not decreased the overall shunt failure rate [45].
Summary
Laparoscopy is safe and useful in inserting primary and redo VPS and in managing distal complications of VPS.
Minimize CO2 insufflation to reduce hypercapnia.
Abdominal surgical history is important in operative planning and may dictate port placement.
References
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Yu S, Bensard DD, Partrick DA, Petty JK, Karrer FM, Hendrickson RJ. Laparoscopic guidance or revision of ventriculoperitoneal shunts in children. JSLS. 2006;10:122–5.PubMedPubMedCentral
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Acharya R, Ramachandran CS, Singh S. Laparoscopic management of abdominal complications in ventriculoperitoneal shunt surgery. J Laparoendosc Adv Surg Tech. 2001;11(3):167–70.CrossRef
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Julian TB, Ribeiro U. Laparoscopic removal of a displaced ventriculoperitoneal shunt. J Laparoendosc Surg. 1995;5(1):55–8.CrossRefPubMed