Outcomes of Laparoscopic Secured Suprahepatic Placement of Distal Catheter of Ventriculo-Peritoneal Shunt in Hydrocephalic Children with Previous Peritoneal Failure

Abstract Background: Various approaches for peritonealcavity have been described for distal shunt placement; mini-laparotomy is the traditional one. Though easy doable by neurosurgeons, this approach carried a significant risk for distal shunt blockage, preperitoneal placement, adhesion formation, visceral injury and increased postoperative pain. Laparoscopic supra hepatic placement of distal catheter of ventriculo-peritoneal shunt (V-P shunt) might offer CSF drainage into the subdiaphragmatic space with its inherent high absorptive capacity, away from omental reactions and bowel entanglement. Aim of Study: To present the technical description and the early outcomes of laparoscopic secured supra-hepatic place-ment of the distal end V-P shunt, regarding distal shunt failures, in hydrocephalic children with previous peritoneal failure. Patients and Methods: A prospective study of 17 hydro-cephalic childrenwho presented with peritoneal failure of previously inserted VP-shunt. Distal shunt placement into the peritoneal cavity was carried out laparoscopically to secure the supra hepatic placement. Close outpatient clinic follow-up was carried out to detect procedure-related morbidities and distal shunt failures. Results: 17 hydrocephalic children admitted to Misr Chil-dren Hospital between 2021 and 2023 were included in this work. The mean age at operation was 6.7 months, with a mean body weight of 7.2kg. The operative time for laparoscopic placement ranged be-tween 35min and 50min (mean 47.5 min). All patients were followed-up for 6 months at minimum. No procedure related mortalities were reported in the enrolled group. Three distal shunt re-failures were documented (18%). Conclusion: Mid-term results proved that laparoscopic se-cured supra-hepatic placement of distal catheter of V-P shunt is a feasible and safe approach in children with previous perito-neal failure. It guarantees effective CSF drainage with low rates of shunt malfunction. Nevertheless, long term follow-up and comparative evaluation with bigger patients’ sample seemed crucial to validate these results.