Laparoscopic versus open approach for implantation of the peritoneal catheter during ventriculoperitoneal shunt placement View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2008-12-13

AUTHORS

Joshua L. Argo, Durgamani K. Yellumahanthi, Naveen Ballem, Mark R. Harrigan, Winfield S. Fisher, Mary M. Wesley, Tracy H. Taylor, Ronald H. Clements

ABSTRACT

BackgroundVentriculoperitoneal shunt (VPS) is the mainstay of therapy for hydrocephalus. The aim of this study is to compare outcomes of laparoscopic (LVPS) versus open (OVPS) techniques for placement of distal VPS catheters.MethodsAll patients undergoing new VPS placement at a tertiary care center between January 2004 and August 2007 were included. Univariate analysis was performed. Wilcoxon rank-sum, chi-square, and Fisher’s exact tests were used to make comparisons between LVPS and OVPS groups. Stepwise backward logistic regression was performed to predict complications requiring operative intervention. A Kaplan–Meier estimate of the survival function was calculated for shunt survival. All data is presented as median and range unless otherwise specified.ResultsFive hundred thirty-five consecutive patients underwent 579 VPS (258 LVPS, 321 OVPS). Median age (52.0 years) and American Society of Anesthesiologists (ASA) score (3) were similar in LVPS and OVPS groups. Body mass index (BMI) [27.8 (17.0–64.9) kg/m2 versus 25.9 (12.3–44.4) kg/m2, p = 0.007], previous operations [0.8 ± 0.9 versus 0.6 ± 0.7, p = 0.004 (mean ± standard deviation)], estimated blood loss (EBL) [20 (0–175) ml versus 25 (0–500) ml, p < 0.001], operating room (OR) time [37.5 (17.0–152.0) min versus 52.0 (20.0–197.0) min, p < 0.001], and length of stay (LOS) [11 (1–77) days versus 14 (1–225) days, p = 0.016] were statistically different between the LVPS and OVPS groups, respectively. LVPS abdominal complication rate of 5.8% and OVPS rate of 6.9% were similar (p = 0.611). Previous abdominal operation [odds ratio (OR) 1.673, 95% confidence interval (CI) 1.100–2.543, p = 0.016] and previous VPS (OR 1.929, 95% CI 1.147–3.243, p = 0.016) were significant predictors of complications requiring operative intervention. Kaplan–Meier analysis demonstrated no difference in survival between LVPS and OVPS groups (p = 0.538), with overall shunt survival of 86.4% at 6 months and 83.0% at 1 year.ConclusionsLVPS is associated with decreased OR time, less blood loss, and shorter LOS with no difference in complication rate when compared OVPS. The laparoscopic approach for VPS is a safe, effective, and readily reproducible alternative to the traditional open approach. More... »

PAGES

1449

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00464-008-0245-x

DOI

http://dx.doi.org/10.1007/s00464-008-0245-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1011210772

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/19083058


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31 schema:description BackgroundVentriculoperitoneal shunt (VPS) is the mainstay of therapy for hydrocephalus. The aim of this study is to compare outcomes of laparoscopic (LVPS) versus open (OVPS) techniques for placement of distal VPS catheters.MethodsAll patients undergoing new VPS placement at a tertiary care center between January 2004 and August 2007 were included. Univariate analysis was performed. Wilcoxon rank-sum, chi-square, and Fisher’s exact tests were used to make comparisons between LVPS and OVPS groups. Stepwise backward logistic regression was performed to predict complications requiring operative intervention. A Kaplan–Meier estimate of the survival function was calculated for shunt survival. All data is presented as median and range unless otherwise specified.ResultsFive hundred thirty-five consecutive patients underwent 579 VPS (258 LVPS, 321 OVPS). Median age (52.0 years) and American Society of Anesthesiologists (ASA) score (3) were similar in LVPS and OVPS groups. Body mass index (BMI) [27.8 (17.0–64.9) kg/m2 versus 25.9 (12.3–44.4) kg/m2, p = 0.007], previous operations [0.8 ± 0.9 versus 0.6 ± 0.7, p = 0.004 (mean ± standard deviation)], estimated blood loss (EBL) [20 (0–175) ml versus 25 (0–500) ml, p < 0.001], operating room (OR) time [37.5 (17.0–152.0) min versus 52.0 (20.0–197.0) min, p < 0.001], and length of stay (LOS) [11 (1–77) days versus 14 (1–225) days, p = 0.016] were statistically different between the LVPS and OVPS groups, respectively. LVPS abdominal complication rate of 5.8% and OVPS rate of 6.9% were similar (p = 0.611). Previous abdominal operation [odds ratio (OR) 1.673, 95% confidence interval (CI) 1.100–2.543, p = 0.016] and previous VPS (OR 1.929, 95% CI 1.147–3.243, p = 0.016) were significant predictors of complications requiring operative intervention. Kaplan–Meier analysis demonstrated no difference in survival between LVPS and OVPS groups (p = 0.538), with overall shunt survival of 86.4% at 6 months and 83.0% at 1 year.ConclusionsLVPS is associated with decreased OR time, less blood loss, and shorter LOS with no difference in complication rate when compared OVPS. The laparoscopic approach for VPS is a safe, effective, and readily reproducible alternative to the traditional open approach.
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38 schema:keywords American Society
39 Anesthesiologists (ASA) score
40 BackgroundVentriculoperitoneal shunt
41 Chi-square
42 ConclusionsLVPS
43 Fisher's exact test
44 Kaplan-Meier analysis
45 Kaplan-Meier estimates
46 LVPS
47 LVPS abdominal complication rate
48 MethodsAll patients
49 OVP group
50 OVPS
51 OVPS rate
52 ResultsFive hundred thirty
53 VPS
54 VPS catheter
55 VPS placement
56 Wilcoxon
57 abdominal complication rate
58 abdominal operations
59 age
60 aim
61 alternative
62 analysis
63 approach
64 backward logistic regression
65 blood loss
66 body mass index
67 care center
68 catheter
69 center
70 comparison
71 complication rate
72 complications
73 consecutive patients
74 data
75 differences
76 distal VPS catheter
77 estimates
78 exact test
79 function
80 group
81 hundred thirty
82 hydrocephalus
83 implantation
84 index
85 intervention
86 laparoscopic
87 laparoscopic approach
88 length
89 length of stay
90 less blood loss
91 logistic regression
92 loss
93 mainstay
94 mainstay of therapy
95 mass index
96 median age
97 months
98 new VPS placement
99 open approach
100 open technique
101 operating room time
102 operation
103 operative intervention
104 outcomes
105 outcomes of laparoscopic
106 overall shunt survival
107 patients
108 peritoneal catheter
109 placement
110 predictors
111 previous VPS
112 previous abdominal operations
113 previous operations
114 range
115 rate
116 regression
117 reproducible alternative
118 room time
119 scores
120 shorter LOS
121 shunt
122 shunt placement
123 shunt survival
124 significant predictors
125 society
126 stay
127 stepwise backward logistic regression
128 study
129 survival
130 survival function
131 technique
132 tertiary care center
133 test
134 therapy
135 thirties
136 time
137 traditional open approach
138 univariate analysis
139 ventriculoperitoneal shunt placement
140 years
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