Laparoscopically assisted versus mini laparotomy for placement of distal catheter of thecoperitoneal shunt in patients with idiopathic intracranial hypertension

BACKGROUND: Thecoperitoneal (TP) shunting is an effective treatment for idiopathic intracranial hypertension (IIH). Laparoscopy adoption in neurosurgical practice, particularly for IIH management, remains sporadically documented, without consensus on its superiority or equivalence in this indication. The aim of this study was to evaluate the operative time, postoperative complications, and outcomes after using the laparoscopically assisted versus mini-laparotomy techniques. METHODS: This retrospective study included 60 females, aged above 18 years old, diagnosed with IIH, and underwent TP shunt surgery using the laparoscopic-assisted or mini-laparotomy for insertion of the intraperitoneal catheter. The patient data was retrieved from the hospital's database. Cases were divided into two groups of equal size. Group A underwent the procedure using laparoscopic assistance, while Group B underwent the procedure using mini laparotomy. RESULTS: Laparoscopic-assisted group experienced significantly shorter operative times (35.5 +/- 10.2 vs. 83.6 +/- 13.5 minutes; P<0.001), less blood loss (10.93 +/- 6.09 vs. 15.73 +/- 5.45 cc; P=0.002) and shorter hospital stay (1.53 +/- 0.68 vs. 2.87 +/- 0.78 days; P<0.001) compared to minilaparotomy group. The laparoscopic-assisted group had a significantly lower overall complication (10%) vs. (60%) in mini-laparotomy group. CONCLUSIONS: Laparoscopically assisted TP shunt insertion offers advantages over mini laparotomy, including direct visualization of the shunt tip and position, reduced risk of complications (shunt migration, obstruction, and extraperitoneal insertion), shorter operative time and improved outcomes in IIH patients.