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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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A prospective randomised controlled trial: Laparoscopically assisted ventriculo-peritoneal shunt placement

Meeting Abstract

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  • Philippe Schucht - Neurochirurgische Klinik, Inselspital, Universität Bern, Switzerland
  • Vanessa Banz - Abteilung für Viscerale Chirurgie und Medizin, Inselspital, Universität Bern, Switzerland
  • Markus Trochsler - Abteilung für Viscerale Chirurgie und Medizin, Inselspital, Universität Bern, Switzerland
  • Samuel Iff - Abteilung für Klinische Forschung, Clinical Trials Unit Bern, Universität Bern, Switzerland
  • Anna-Katharina Krähenbühl - Neurochirurgische Klinik, Inselspital, Universität Bern, Switzerland
  • Michael Reinert - Department of Neurosurgery, Ospedale Cantonale di Lugano, Switzerland
  • Jürgen Beck - Neurochirurgische Klinik, Inselspital, Universität Bern, Switzerland
  • Andreas Raabe - Neurochirurgische Klinik, Inselspital, Universität Bern, Switzerland
  • Daniel Candinas - Abteilung für Viscerale Chirurgie und Medizin, Inselspital, Universität Bern, Switzerland
  • Dominique Kuhlen - Department of Neurosurgery, Ospedale Cantonale di Lugano, Switzerland
  • Luigi Mariani - Neurochirurgische Klinik, Universitätskrankenhaus Basel, Switzerland

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.04.04

doi: 10.3205/14dgnc016, urn:nbn:de:0183-14dgnc0167

Published: May 13, 2014

© 2014 Schucht et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: In ventriculo-peritoneal shunt (VPS) surgery, laparoscopic assistance can be used for the placement of the peritoneal catheter. Up to now, only retrospective and non-randomised prospective studies have investigated the efficacy of laparoscopic shunt placement, and reported decreased dysfunction rates of the distal shunt compared to open surgery cohorts. In this randomised controlled trial, we compared the rate of shunt failures for laparoscopic assistance versus traditional mini-laparotomy.

Method: 120 patients scheduled for VPS surgery were randomised to laparoscopic or mini-laparotomy (i.e. open insertion) of the peritoneal catheter. The primary endpoint was the rate of overall shunt complication/failure within 12 months after surgery. Secondary endpoints were distal shunt failure rate, overall complication/failure, duration of surgery and hospitalization, as well as morbidity.

Results: Overall shunt complication/failure rate was 15% (9 patients) in the laparoscopic group and 18.3% (11 patients) in the mini-laparotomy group (p=0.404). Patients in the laparoscopic group had no distal shunt failures, as compared to 5 of 60 (8%) in the mini-laparotomy group (p=0.029). Intra-operative complications occurred in two patients (laparoscopic group), and abdominal pain led to catheter removal in one patient per group. Infections occurred in one patient in the laparoscopic group and three in the mini-laparotomy group. Mean durations of surgery and hospitalization were similar in the two groups.

Conclusions: In our trial, a significant reduction in the rate of distal shunt failures was observed after laparoscopic VPS placement as compared to mini-laparotomy. The difference in overall shunt failures did not reach statistical significance.

Notes: Philippe Schucht and Vanessa Banz contributed equally to this work. Dominique Kuhlen and Luigi Mariani contributed equally to this work