Circumbilical Access for Ventriculoperitoneal Bypass Insertion in Adults

Abstract

Introduction The use of a minilaparotomy for catheter implantation can bring important complications such as adhesions, intestinal lesions, incisional hernias and postoperative pain. In neurosurgery, the umbilical access, currently widely used by surgeons of different specialties mainly for its aesthetic results, is still restricted by the unfamiliarity of the access. Material and Method During the period between 2019 and 2020, a total of 12 patients who required ventricular bypass were selected, using circumbilical access for insertion of the peritoneal catheter and followed up for 12 months to analyze possible complications. Description of the Technique The surgeon responsible for the abdomen performs an umbilical incision bordering the upper edge of the upper ring, avoiding the mamelon, quickly finding the linea alba under the umbilical plane, which after dissection allows reaching the peritoneum, without breaking the rectus muscles. The peritoneum can then be opened under visual control. Results All patients presented resolution of hydrocephalus with good aesthetic results and without complications. Discussion The aesthetic result of the transumbilical procedure was the stimulus for the development of the technique that proved to be easy, safe, cheap, and aesthetic. Initially, the ease of access to the peritoneal cavity is clear, in addition to avoiding manipulation of the rectus abdominis muscle, which improves postoperative pain. Conclusion The circumbilical access for the implantation of a ventriculoperitoneal shunt is safe, effective and has a better aesthetic result for adult patients and should be part of the operative arsenal of neurosurgeons.

Keywords

• ventriculoperitoneal shunt
• hydrocephalus
• umbilicus