Biomedical Letters

A Laparoscopic Fixation of Distal Catheter of the Ventriculoperitoneal shunt with Falciform Ligament in Supra-Hepatic Space by Modified Falciform Technique

Khalil Ahmad Hijrat 1, Xin Shi 2*, Ismatullah Soufiany 1, Sulav Pradhan 1, Congxing Liu 1, Xiaoyuan Guo 3, Zheng Su 3, Xihai Wang 3

1 School of Medicine, Southeast University, 210009, Nanjing, People’s Republic of China.

2 Department of General Surgery, Zhong Da Hospital, Southeast University, 210009, Nanjing, People’s Republic of China.

3 Department of Neurosurgery, Zhong Da Hospital, Southeast University, 210009, Nanjing, People’s Republic of China.

Abstract

Laparoscopy-assisted distal catheter insertion of the Ventriculoperitoneal shunt (VPS) in the abdomen is performed universally and numerous maneuvers have been executed for placement of the distal end of VPS in the peritoneal cavity. Most recently, a falciform ligament of the liver has been utilized as a support for the distal shunt, without clipping or ligation of the catheter. Despite the improvements in shunt procedures, abdominal complication like infection, migration, obstruction/blockage, perforation and pseudocyst still attribute a major part in revision surgeries. We have brought modification in previously described “falciform technique” to overcome the manifestation related to the distal shunt. Twenty-seven patients with hydrocephalus underwent Laparoscopic VPS with the modified falciform technique in Zhong Da Hospital, Nanjing China between June 2013 and November 2016. A threaded strap was formed around the catheter before insertion into the abdominal cavity. A hole was made in a falciform ligament and the distal catheter was clamped with the falciform ligament in supra-hepatic space, using the threaded strap as a holder. All the 27 patients underwent VPS surgery using modified technique. No abdominal complications related to the distal shunt were found except, 3 patients (11%) complained of right upper quadrant abdominal discomfort. Proximal infection (2 cases, 7%) and blockage (1 case, 4%) were the factors contributing to revision surgeries during 471 days of the mean follow-up period. The “Modified Falciform Technique” for emplacement of the distal catheter in supra-hepatic space significantly reduces the rates of postoperative peritoneal complications and revisions of VPS for a longer period of time.

Keywords: Laparoscopic, hydrocephalus, falciform ligament, VPS, catheter.

Received February 03, 2017 Revised March 06, 2017 Accepted March 21, 2017

*Correspondence: Xin Shi Email shixined@126.com Contact: +86-025-83262312