Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

Ventriculoperitoneal shunting (VPS) is the most accepted treatment for hydrocephalus but carries a significant risk of VP shunt malfunction. This study aims to compare the different trends in placement of the peritoneal end of the VP shunt whether through the traditional laparotomy, laparoscopic or Suprahepatic in accordance to its influence on postoperative outcome Materials and Methods: Between January 2017 and September 2017, a total of 45 patients, less than 1 year old, underwent first time VPS placement at cairo university specialized pediatric hospitals,15 were laparoscopically guided and 15 were done by traditional laparotomy and placed in the subhepatic space and 15 cases by laparotomy and suprahepatic placement of the distal end. We analyzed independent variables (age, gender, clinical presentation and surgical technique) and dependent variables (operative time and post{u2011}operative complications) and occurrence of shunt failure. Results: The mean operative time was 44 (range, 25-63.0) min, but in the laparoscopic group the mean operative time was shorter, with 37.5 (range, 25- 50) mins when compared with the time spent on Laparotomy and Free peritoneal placement cases requiring 42.5 (range, 25- 60) mins and with Laparotomy and suprahepatic placement 45 (range27-63) mins, (P < 0.05).Patients were routinely followed for a minimum of 6 months after VPS placement The incidence of shunt failure during the entire follow{u2011}up period was significantly different, statistically, between the three groups, occurring in 7.1 % in the laparoscopic group and 26.7% in the traditional laparotomy group and 21.4 % in the suprahepatic group, (P = 0.601)

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