The application of improved abdominal wall punctures technique in ventriculoperitoneal shunt for hydrocephalus: a retrospective analysis versus open mini-laparotomy

Abstract

Purpose: Ventriculoperitoneal shunt (VPS) remains as one of the main treatment for hydrocephalus. The traditional technique for placing the distal ends of shunts is via a mini-laparotomy. However, laparotomies are relatively time consuming. Trocars to penetrate abdominal wall by blind puncture have been used. Here, we report on the abdominal wall puncture technique, and compare the possible complications and outcomes with traditional mini-laparotomy.Materials and methods: We use a 5mm incision at the inverse McBurney point. The abdominal wall on both sides of the incision point is lifted with two towel clips prior to puncture to create a potential gap between the abdominal wall and viscera. After the puncture, a guide wire is inserted followed by a dilator, introducer and the distal shunt tubing using a Seldinger technique. In this process, the operator feels resistance give with breakthrough of parietal peritoneal. After the insertion of introducer, a negative pressure injection test helps confirm whether the introducer is inside the peritoneum.Results: Operative time is less than with mini-laparotomies. Postoperative abdominal symptoms are mild. Out of 29 patients there were no puncture related complications.Conclusion: The improved abdominal-wall puncture technique is a simple, fast, economical and effective method. Patients, who are treated by the method, generally experience rapid postoperative recoveries.