ABSTRACT
Objective • To compare the clinical outcomes between two-trocar laparoscopy-assisted ventriculoperitoneal shunt (LAVPS) and conventional open ventriculoperitoneal shunt (OVPS), and explore the clinical practice and experience of the placement of distal catheter in two-trocar LAVPS. Methods • A total of 308 patients with hydrocephalus who underwent ventriculoperitoneal shunt (VPS) from January 2016 to December 2018 in the Department of Neurosurgery at Renji Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. Among them, there were 90 patients in the LAVPS group (Group L), and the two-trocar method and the original suture loop method were adopted to place the distal catheter in the right hepato-diaphragmatic space. For the other 218 patients in the conventional OVPS group (Group O), the laparotomy approach was adopted to put the distal catheter into the left lower abdominal cavity through the midline incision. The operation time and complications of the distal catheter between the two groups were compared. Results • Compared with Group O, the mean operation time was significantly reduced in Group L (54 min vs 90 min, P=0.000), and the incidence of distal catheter complications was also significantly decreased (0 vs 9.6%, P=0.002). In Group L, only one case of visceral injury, one case of distal catheter migration and one case of proximal catheter obstruction occurred. The incidences of infection and obstruction of the distal catheters were 0 in Group L, significantly lower than those in Group O (0 vs 4.6%, P=0.039; 0 vs 5.0%, P=0.030). In Group O, 10 cases of distal catheter infection, 11 cases of obstruction, 4 cases of visceral injury and 2 cases of incisional hernia occurred. Conclusion • The modified two-trocar LAVPS, of which the distal catheter was guided by a suture loop method and placed in the right hepato-diaphragmatic space, is a safe, economical and simple surgical procedure that is more effective in treating hydrocephalus of various origins than conventional OVPS.
ABSTRACT
La ascitis por Líquido cefalorraquídeo es una complicación relativamente rara que se ha reportado en la literatura prácticamente desde 1972. Junto con el pseudoquiste abdominal corresponde a un 2% de las complicaciones de las derivaciones ventriculoperitoneales. Múltiples teorías han intentado explicar la patogenia de esta patología. A continuación se presenta el caso de un paciente de 36 años del Hospital México quien luego de 11 años de colocada una DVP desarrolla un cuadro de ascitis por LCR cuyos estudios clínicos no mostraron causa desencadenante evidente del cuadro por lo que fue necesario realizar una derivación ventrículo-atrial. Se incluye además una revisión de la literatura vigente.
Ascites by cerebrospinal fluid (CSF) is a relatively rare complication that has been reported in the literature almost since 1972. Along with abdominal pseudocyst corresponds to 2% of the complications of ventriculoperitoneal shunts (VPS) . Multiple theories have attempted to explain the pathogenesis of this disease. Then the case of a patient of 36 years of the Hospital Mexico who after 11 years VPS placed one develops a picture of ascites CSF is presented whose clinical studies showed no obvious precipitating cause it was necessary to perform a ventriculo -atrial shunt. A review of the current literature is also included.