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Peritoneal insertion of shunts in children: comparison between trocar and laparoscopically guided insertion

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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.

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Acknowledgments

We thank Tomer Ziv-Baran, PhD, for assistance with statistical analysis, and Mrs. Adina Sherer for editorial assistance.

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Author notes

  1. Marga Serafimova and Jehuda Soleman contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Dana Children’s Hospital, Tel-Aviv Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel

    Marga Serafimova, Jehuda Soleman, Shlomi Constantini & Jonathan Roth

  2. Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland

    Jehuda Soleman & Raphael Guzman

  3. Faculty of Medicine, University of Basel, Basel, Switzerland

    Jehuda Soleman, Tabea Stoessel & Raphael Guzman

  4. Tel-Aviv University, Tel-Aviv, Israel

    Shlomi Constantini & Jonathan Roth

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  1. Marga Serafimova
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  3. Tabea Stoessel
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Correspondence to Jonathan Roth.

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We conducted this study following an institutional review board approval from both institutes. Both ethics committees, due to the retrospective nature of the study, waived patient and parental consents.

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Serafimova, M., Soleman, J., Stoessel, T. et al. Peritoneal insertion of shunts in children: comparison between trocar and laparoscopically guided insertion. Childs Nerv Syst 37, 115–123 (2021). https://doi.org/10.1007/s00381-020-04760-x

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