Minimally invasive abdominal catheter placement in ventriculoperitoneal shunt patients is associated with lower abdominal catheter complications: A single center experience

Abstract Purpose Ventriculoperitoneal (VP) shunt placement represents one of the modalities for hydrocephalus (HC) requiring cerebrospinal fluid (CSF) flow diversion and is a complication-abundant procedure. Reducing VP-shunt placement procedure time and optimizing abdominal catheter placement could help surgical VP-shunt complication rates. Methods A 7-year, single-center retrospective analysis was performed on adult patients who underwent minimally invasive (MI) trocar-guided direct peritoneocentesis for abdominal catheter insertion during VP-shunt implantation. This was compared with a reference cohort undergoing standard insertion in 2018 pertaining to surgical procedure time and method related complication rates (abdominal catheter migration and surgical site or wound infection), with matched-pair analysis used to confirm the observations made. Results Between 2015 and 2022, 25 adult patients (average age: 57 years) underwent VP-shunt insertion with MI abdominal catheter placement and showed a significantly shorter average procedure time (35.1 minutes ± 16.3) compared to 59.2 ± 16.2 minutes in the reference cohort (n = 103) undergoing standard insertion (p < 0.001). The rate of abdominal catheter migration or shunt infections in the MI group was 0%, while the standard insertion cohort showed rates of 16% and 8% respectively (p < 0.001). No cases of bowel injury were reported in any of the cohorts. After a cohort-matched analysis of n = 25 MI and n = 25 standard method patients, significant differences in surgical procedure time were confirmed (35.1 vs 75.1 minutes, p < 0.001). In addition, a higher rate of abdominal catheter migration (0% vs 8%, p < 0.001) and infection rate (0% vs 8%, p < 0.001) in the standard reference cohort was observed. Conclusion Using a direct MI trocar-based peritoneocentesis approach was associated with a decreased surgical duration time and subsequently reduced abdominal catheter migration and shunt infection rate compared to a standard insertion cohort. These findings highlight an alternative approach that could help reduce VP-shunt complications in adult patients.