Laparoscopic anchoring of peritoneal catheters using surgical mesh - a promising approach for recurrent extrinsic ventriculoperitoneal shunt migration

Abstract

Background: Ventriculoperitoneal shunts (VPS) remain the standard of care for cerebrospinal fluid (CSF) diversion in hydrocephalus and idiopathic intracranial hypertension (IIH). Despite their efficacy, they carry a risk of distal catheter migration, which can result in repeated revisions and increased morbidity.

Methods: Three patients with recurrent distal catheter migration, two with IIH and one with hydrocephalus secondary to residual intraventricular tumour, underwent laparoscopic revision. All patients had a high body mass index (BMI) > 40 and multiple prior shunt revisions. The distal catheter was externalised, CSF flow confirmed, the catheter thread through a Parietex composite mesh patch in a zigzag pattern. The mesh-catheter construct was introduced laparoscopically into the peritoneal cavity and anchored to the abdominal wall with tacks under direct visual guidance.

Results: Postoperative follow-up showed no further catheter migration or shunt malfunction in any of the three cases. Neurological and visual symptoms resolved or improved, and imaging demonstrated stable shunt function without new complications. No mesh-related infections or adverse events were observed during this follow-up period.

Conclusion: Laparoscopic surgical mesh anchoring appears to be a safe and effective technique for preventing recurrent distal catheter migration in VPS, particularly in high-risk populations such as patients with obesity. By securing the catheter to the abdominal wall with a mesh scaffold, this approach provides enhanced mechanical stability and reduces the need for repeated revisions.

Keywords: Ventriculoperitoneal shunt; ependymoma; hydrocephalus; idiopathic intracranial hypertension; shunt migration.