Laparoscopy versus mini-laparotomy peritoneal catheter insertion of ventriculoperitoneal shunts: a systematic review and meta-analysis

被引:28
|
作者
He, Mingliang [1 ]
Ouyang, Leping [1 ]
Wang, Shengwen [1 ]
Zheng, Meiguang [1 ]
Liu, Anmin [1 ]
机构
[1] Sun Yat Sen Univ, Sun Yat Sen Mem Hosp, Dept Neurosurg, Yanjiang West Rd 107, Guangzhou 510120, Guangdong, Peoples R China
关键词
hydrocephalus; laparoscopy; mini-laparotomy; ventriculoperitoneal shunt; meta-analysis; DISTAL CATHETER; PLACEMENT; HYDROCEPHALUS; IMPLANTATION; ADULTS; EXPERIENCE; FAILURES;
D O I
10.3171/2016.5.FOCUS1637
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion. METHODS A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library data-bases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. RESULTS Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25-0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8-23), operative time was shorter (mean difference [MD], -12.84; 95% CI -20.68 to -5.00; p = 0.001), and blood loss was less (MD -9.93, 95% CI -17.56 to -2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD -1.77, 95% CI -3.67 to 0.13; p = 0.07). CONCLUSIONS To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant.
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页数:10
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