Falciform technique in laparoscopic revision of distal catheter obstruction: an evaluation

Abstract

Background: Ventriculoperitoneal (VP) shunting is a cornerstone treatment for hydrocephalus, a condition characterized by the abnormal accumulation of cerebrospinal fluid in the ventricles of the brain. Despite its efficacy, this procedure is associated with various complications, among which distal catheter obstruction poses significant challenges. This study aimed to evaluate the effectiveness of the ‘falciform technique’ in laparoscopic revision of distal catheter obstructions, offering a novel approach to mitigate this prevalent issue. Materials and methods: This study retrospectively analyzed 28 patients with VP shunt distal catheter obstructions who underwent laparoscopy-assisted shunt revision between January 2016 and June 2022. All of these were done using the ‘falciform technique’ with the fixation of the distal catheter to the falciform ligament in supra-hepatic space. Results: The most common etiology of primary shunt surgery was hydrocephalus, followed by intracranial hemorrhage (42.9%) and traumatic brain injury (32.1%). Normal pressure hydrocephalus occurs in 14.3% of cases. Fifteen patients (53.6%) required revision surgery within 1 year of index surgery. Thirteen patients (46.4%) underwent revision surgery more than 1 year after the index surgery, either as a first revision or subsequent revision. The average surgery time was 32.1±14.7 min and hospital stay was 4.2±1.8 days. After a mean follow-up period of at 20.3±8.7 months, except for three patients who died from other causes (two patients due to pneumonia and one due to exhaustion), there were no shunt-related complications in the remaining 25 patients. Conclusions: Laparoscopy with the application of ‘falciform technique’ is a safe and highly effective method in distal catheter obstruction revision following VP shunt.