Marga Serafimova1, Jehuda Soleman1,2,3, Tabea Stoessel3, Raphael Guzman2,3, Shlomi Constantini1,4, Jonathan Roth5,6. 1. Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel. 2. Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland. 3. Faculty of Medicine, University of Basel, Basel, Switzerland. 4. Tel-Aviv University, Tel-Aviv, Israel. 5. Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel. jonaroth@gmail.com. 6. Tel-Aviv University, Tel-Aviv, Israel. jonaroth@gmail.com.
Abstract
PURPOSE: Ventriculo-peritoneal shunts are commonly used for treating hydrocephalus for all age groups. There are 3 main methods for shunt placement into the peritoneum: mini laparotomy, laparoscopically guided, or percutaneously with a trocar. There is limited literature comparing between these techniques in the pediatric population, and specifically-the trocar has not been compared with laparoscopy. The goal of this study is to compare trocar and laparoscopy use, with respect to safety and potential need for future shunt revisions. METHODS: Data was retrospectively collected from 2 centers for children (< 18 years old) who underwent a primary insertion of a CSF shunt to the peritoneum, and had no prior abdominal surgery or significant abdominal disease. One center used a trocar, and the other laparoscopic guidance. Demographics, surgical time, and shunt complications were analyzed. Primary endpoint was distal shunt malfunction, either technique-related or non-technique-related. RESULTS: Two hundred fifty-seven children (220 trocar, 37 laparoscopy) were included. The groups were similar with regard to age at surgery and etiology of hydrocephalus. Trocar use was associated with a slightly higher, although statistically insignificant, rate of technique-related distal complications (4.1% vs 0, p = 0.37). Following propensity score matching, there was no statistically significant difference in any shunt complication between both groups. Trocar use was associated with shorter surgery, and less surgical personnel. CONCLUSIONS: In primary shunt surgery in children, abdominal placement of the catheter using a trocar or laparoscopic guidance is safe, and associated with a low distal malfunction rate, with no statistically significant differences between both techniques.
PURPOSE: Ventriculo-peritoneal shunts are commonly used for treating hydrocephalus for all age groups. There are 3 main methods for shunt placement into the peritoneum: mini laparotomy, laparoscopically guided, or percutaneously with a trocar. There is limited literature comparing between these techniques in the pediatric population, and specifically-the trocar has not been compared with laparoscopy. The goal of this study is to compare trocar and laparoscopy use, with respect to safety and potential need for future shunt revisions. METHODS: Data was retrospectively collected from 2 centers for children (< 18 years old) who underwent a primary insertion of a CSF shunt to the peritoneum, and had no prior abdominal surgery or significant abdominal disease. One center used a trocar, and the other laparoscopic guidance. Demographics, surgical time, and shunt complications were analyzed. Primary endpoint was distal shunt malfunction, either technique-related or non-technique-related. RESULTS: Two hundred fifty-seven children (220 trocar, 37 laparoscopy) were included. The groups were similar with regard to age at surgery and etiology of hydrocephalus. Trocar use was associated with a slightly higher, although statistically insignificant, rate of technique-related distal complications (4.1% vs 0, p = 0.37). Following propensity score matching, there was no statistically significant difference in any shunt complication between both groups. Trocar use was associated with shorter surgery, and less surgical personnel. CONCLUSIONS: In primary shunt surgery in children, abdominal placement of the catheter using a trocar or laparoscopic guidance is safe, and associated with a low distal malfunction rate, with no statistically significant differences between both techniques.
Authors: Joshua L Argo; Durgamani K Yellumahanthi; Naveen Ballem; Mark R Harrigan; Winfield S Fisher; Mary M Wesley; Tracy H Taylor; Ronald H Clements Journal: Surg Endosc Date: 2008-12-13 Impact factor: 4.584
Authors: Pablo F Recinos; Jonathan A Pindrik; Mazen I Bedri; Edward S Ahn; George I Jallo; Violette Renard Recinos Journal: J Neurosurg Pediatr Date: 2013-02-22 Impact factor: 2.375
Authors: Sara Iglesias; Bienvenido Ros; Álvaro Martín; Antonio Carrasco; Miguel Segura; Andrea Delgado; Francisca Rius; Miguel Ángel Arráez Journal: Childs Nerv Syst Date: 2016-08-05 Impact factor: 1.475
Authors: Chevis N Shannon; Tamara D Simon; Gavin T Reed; Frank A Franklin; Russell S Kirby; Meredith L Kilgore; John C Wellons Journal: J Neurosurg Pediatr Date: 2011-12 Impact factor: 2.375
Authors: Aodhnait S Fahy; Stephanie Tung; Maria Lamberti-Pasculli; James Drake; Abhaya V Kulkarni; Justin T Gerstle Journal: J Pediatr Surg Date: 2018-07-06 Impact factor: 2.545
Authors: Graham Mulvaney; Michael Arnold; Caroline Reinke; Scott Wait; Mark Van Poppel; Scott McLanahan; Thomas Schmelzer; Graham Cosper; Andrew Schulman; Sarah Jernigan Journal: Cureus Date: 2022-06-18