Biography
Biography: Fares Nigim
Abstract
Objectives: Ventriculoperitoneal shunt (VPS) is the mainstay in the treatment of hydrocephalus. But carries a significant risk of malfunctioning. This study aims to compare the outcomes of laparoscopic (LVPS) versus Open (OVPS) VPS-placement and reviews the literature from 1993 – 2012. Methods: Between 2003 and 2012, 232 patients underwent first time VPS placement at BIDMC. Of those, 155 were laparoscopically guided and 77 were done conventionally. We analyzed independent variables (age, gender, medical history, clinical presentation, indication for surgery and surgical technique) and dependent variables (operative time, postoperative complications, length of stay in the hospital, and occurrence of shunt failure). Results: Mean operative time was 43.7 minutes (18.0 – 102.0) in the laparoscopic group versus 63.0 minutes (30.0 – 151.0) in the open group, (P < 0.05). Length of stay was similar, 5 days in the laparoscopic and in the open group, (P = 0.945). The incidence of shunt failure during the entire follow up period was not statistically different between the two groups, occurring in 14.1% in the laparoscopic group and 16.9% in the open group, (P = 0.601). Kaplan-Meier analysis demonstrated no difference in shunt survival between the two groups (P = 0.868), with functionality in 85% at 6-months and 78.5% at 1-year. Conclusion: According to our results, laparoscopic VPS-placement works as well as open VPS placement. Although laparoscopy is not routinely indicated, we suggest a prospective study to assess its value as an alternative technique especially in obese patients and patients with previous abdominal operations.