Laparotomy vs minimally invasive laparoscopic ventriculoperitoneal shunt placement for hydrocephalus: A systematic review and meta-analysis

Abstract Ventriculoperitoneal shunt (VPS) surgery is the most commonly used method for the treatment of hydrocephalus. Traditionally, distal catheters in the VPS surgery have been placed either through a standard small open laparotomy or via a laparoscopic technique. Although there are many studies demonstrating the benefits of a minimally invasive approach, limited research has directly compared the two techniques used in VPS surgery. The present meta-analysis aims to provide the first comprehensive review of all published observational studies and randomized controlled trials reporting outcomes of laparotomy and laparoscopy in VPS. Electronic searches were performed using six databases from their inception to February 2015. Relevant studies comparing conventional laparotomy and a laparoscopic video-guided approach in VPS were included. Data were extracted and analyzed according to predefined clinical endpoints. A total of ten studies were identified for inclusion in the present analysis. Results indicated that the laparoscopic technique was associated with a slight but significant reduction in operating time (∼10 min), a significantly lower rate of abdominal malposition, distal obstruction and distal shunt failure. There was no difference between the laparotomic and laparoscopic approaches in the length of hospital stay, complication rate, proximal shunt failure or infection rate. The present systematic review and meta-analysis demonstrated that the laparoscopic technique in VPS surgery is associated with reduced shunt failure and abdominal malposition compared to the open laparotomy technique, with no significant difference in rates of infection or other complications. The lack of studies with high levels of evidence may contribute to bias in our conclusions and the long-term relative merits require validation by further prospective, randomized studies.