Lumboperitoneal shunt surgery via lateral abdominal laparotomy

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OBJECTIVE

One of the technical problems encountered in performing lumboperitoneal shunt (LPS) surgery involves operative positioning of the patient. To insert the spinal catheter into the subarachnoid lumbar space, LPS is usually performed with the patient in the lateral decubitus position. However, laparotomy around the periumbilical region, especially in obese patients in the lateral decubitus position, can be quite difficult. Thus, the authors added a simple modification to the laparotomy for LPS, altering the laparotomy site to the lateral side of the patient’s trunk. The aim of this study was to analyze this method in terms of technical features and outcomes.

METHODS

Two LPS procedures were compared: routine periumbilical anterior abdominal laparotomy and our modified method using lateral abdominal laparotomy. The first 11 consecutive cases underwent routine anterior abdominal laparotomy with position changes or tilting of the operative bed, whereas the next 17 consecutive cases underwent lateral abdominal laparotomy not requiring position changes.

RESULTS

In the anterior abdominal laparotomy group, the mean operative time was 72.36 ± 24.63 minutes. One patient had a spinal tube tear that required revision of the LPS 2 years postoperatively. In the lateral abdominal laparotomy group, the mean operative time was 38.82 ± 13.87 minutes. One patient experienced a postoperative headache and exhibited a thin, chronic subdural hematoma on imaging studies, which disappeared after adjustment of the valve pressure.

CONCLUSIONS

In the current series, the operative duration was shorter in the lateral abdominal group compared with the anterior abdominal group, with no differences in complication rates. Lateral abdominal laparotomy simplifies LPS.

ABBREVIATIONS iNPH = idiopathic normal pressure hydrocephalus; LPS = lumboperitoneal shunt; mRS = modified Rankin Scale; NPH = normal pressure hydrocephalus; VPS = ventriculoperitoneal shunt.
Article Information

Contributor Notes

Correspondence Yukihiro Goto: Saiseikai Shiga Hospital, Shiga Prefecture, Japan. yoursongmysong@hotmail.com.INCLUDE WHEN CITING Published online December 20, 2019; DOI: 10.3171/2019.10.SPINE19957.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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