Laparoscopy Versus Laparotomy for Ventriculoperitoneal Shunt Placement: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: Laparoscopy is a minimally invasive alternative to laparotomy for ventriculoperitoneal shunt. However, recent evidence has renewed the debate over which technique is preferable. Therefore, we aimed to conduct a meta-analysis to compare these procedures. METHODS: We searched PubMed, Embase, Web of Science, and Cochrane Library for studies comparing laparoscopy with laparotomy in patients undergoing ventriculoperitoneal shunt until August 2024. Outcomes included overall, distal, and proximal shunt failures; intraoperative complications; operation time; length of stay; and estimated blood loss. Statistical analysis was performed using R Studio (version 2024.04.1+748). RESULTS: We included 27 studies with a total of 6390 patients, of whom 2549 (39.9%) underwent laparoscopy. The most common etiologies were normal pressure hydrocephalus (34.1%), subarachnoid hemorrhage (22.0%), and neoplasm (19.4%). Laparoscopy was associated with significant reductions in overall shunt failures (risk ratio [RR] 0.71, 95% CI: 0.54-0.94; I2 = 73%) and distal shunt failures (RR 0.48, 95% CI: 0.31-0.74; I2 = 35%). However, no statistical differences were observed in proximal shunt failure (RR 1.14, 95% CI: 0.90-1.46; I2 = 0%) and intraoperative complications (RR 1.11, 95% CI: 0.51-2.39; I2 = 0%). Moreover, laparoscopy was associated with a shorter operation time (mean difference [MD] -14.76 minutes, 95% CI: -20.54 to -8.98; I2 = 96%) and reduced estimated blood loss (MD -8.93 mL, 95% CI: -14.70 to -3.17; I2 = 56%), although length of stay was similar between groups (MD -0.93 days, 95% CI: -2.05 to 0.19; I2 = 64%). CONCLUSION: Laparoscopy is associated with lower overall and distal shunt failures, as well as reduced operation time and estimated blood loss. These findings suggest that laparoscopy may be preferable to laparotomy.