Conventional versus laparoscopic ventriculoperitoneal shunt placement: A retrospective study with prospectively collected data

Introduction: Ventriculoperitoneal (VP) shunt placement is among the most common neurosurgical procedures. Distal shunt failure remains a significant complication, often necessitating revision surgery. Laparoscopic placement offers direct visualisation of catheter positioning and cerebrospinal fluid flow confirmation. This study compares outcomes of open mini-laparotomy versus laparoscopic distal catheter placement. Patients and Methods: A retrospective observational study of 150 patients (75 per group) undergoing VP shunt placement at Sir Ganga Ram Hospital, New Delhi, from May 2017 to April 2020. Group A underwent open mini-laparotomy; Group B underwent laparoscopic distal catheter placement. The primary outcome was distal shunt failure requiring revision surgery. Secondary outcomes included operative duration, post-operative pain (Visual Analogue Scale [VAS]), analgesic requirements, bowel recovery, and hospital stay. Results: Groups were comparable in demographics. Mean total operative time was similar (86.7 ± 16.7 vs. 87.7 ± 17.0 min; P = 0.699). Abdominal operative time was significantly shorter in Group B (28.5 ± 5.3 vs. 37.7 ± 7.2 min; P < 0.001). Mean VAS score was significantly lower in Group B (2.45 ± 1.09 vs. 4.19 ± 1.15; P < 0.001). Post-operative nausea/vomiting (10.7% vs. 26.7%; P = 0.012), analgesic requirement on post-operative day (POD) 2 (26.7% vs. 58.7%; P < 0.001), and bowel recovery time (2.61 ± 1.10 vs. 6.04 ± 1.86 h; P < 0.001) all favoured Group B. Shunt revision rate was significantly lower in Group B (4% vs. 17.3%; P = 0.015). Conclusions: Laparoscopic distal VP shunt placement is safe, feasible, and associated with significantly lower shunt revision rates and superior perioperative recovery compared to open mini-laparotomy.