Laparoscopic-assisted versus Open Placement of Ventriculoperitoneal Shunts in the Pediatric Population with Congenital Hydrocephalus: A Randomized Controlled Trial.

Abstract

Background: Ventriculoperitoneal (VP) shunt is the standard surgical treatment for hydrocephalus. Conventional open insertion of the distal catheter is widely practiced; however, laparoscopic-assisted right VP shunt (LARVS) provides direct visualization of peritoneal entry, potentially reducing complications and improving accuracy.

Aim: The aim of this study was to compare LARVS with conventional open right VP shunt (RVS) in terms of operative parameters, postoperative outcomes, and complication rates.

Materials and methods: A randomized controlled trial was conducted on 76 patients undergoing primary RVS between July 2020 and August 2024. The patients were divided into two groups: Group A - LARVS (n = 37) and Group B - RVS (n = 39). The data analyzed included age, operative time, duration of hospital stay, type of hydrocephalus, and postoperative complications. Statistical analysis was performed using the t-test and Chi-square tests; P < 0.05 was considered statistically significant.

Results: The two groups were comparable in terms of baseline characteristics (age, P = 0.089). The mean operative time was 62.14 ± 8.9 min for LARVS and 64.97 ± 9.8 min for RVS (P = 0.296). The average hospital stay was 5.94 ± 1.1 days for LARVS and 5.55 ± 1.2 days for RVS (P = 0.797). Noncommunicating hydrocephalus predominated (LARVS: 89%; RVS: 87%). Overall complication rates were low and not significantly different (P = 0.300). Shunt revision was required in 8.1% (LARVS) and 7.7% (RVS), cerebrospinal fluid leak occurred in 2.6% of the RVS group and 2.7% in the LARVS group. No visceral injury or port-related morbidity occurred in the laparoscopic group.

Conclusion: LARVS is a safe and effective alternative to open RVS. Both approaches yield comparable operative times and outcomes, with LARVS offering the added advantage of direct peritoneal visualization, although its impact on morbidity was not statistically different in this cohort.Type of study: Clinical research.Level of evidence: Level II.