Purpose: Distal ventriculoperitoneal shunt catheter placement has traditionally been performed using a small abdominal incision. However, because this is done blindly, shunt failure frequently occurs secondary to inaccurate peritoneal catheter tip placement. Although laparoscopy has been used to facilitate peritoneal catheter placement, it is not usually the primary method. This study aimed to determine the usefulness and potential advantages of laparoscopic distal catheter placement as the primary approach through comparison with conventional minilaparotomy technique. Methods: Between August 2005 and December 2007, 80 patients with hydrocephalus (no neonates) underwent ventriculoperitoneal shunt placement at Konkuk University Medical Center. Forty-nine patients underwent laparoscopic distal shunt placement during this period. The results were compared with those of another group of 31 patients who underwent surgery by conventional approach, using retrospective analysis. Results: No statistically significant difference in the rate of shunt faillure was noted between the two groups. Age, sex, underlying disease, preoperative infectious disease, preoperative leukocytosis, preoperative increased C-reactive protein (CRP), and operative time proved to be insignificant risk factors for inducing shunt failure. Shunt failure was increased principally due to shunt malfunction in patients in the mini-laparotomy group who had undergone previous abdominal surgery. However, shunt malfunction was significantly reduced by laparoscopic distal catheter placement. Conclusion: The advantage of the laparoscopic approach was confirmed by noting precise catheter positioning and assessing cerebrospinal fluid (CSF) flow under direct visualization. We recommend laparoscopic-assisted distal ventriculoperitoneal shunt placement as a primary technique.

Keywords: Laparoscopy, Peritoneal distal catheter, Ventriculoperitoneal shunt