{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T12:45:04Z","timestamp":1767357904271,"version":"3.48.0"},"reference-count":21,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Hydrocephalus is primarily treated with open ventriculoperitoneal shunt (VPS) insertion, but laparoscopy-assisted VPS insertion has emerged as an alternative. This study compared outcomes and complications of laparoscopic versus open VPS insertion without a peel-away sheath in pediatric patients. Methods: A retrospective review was conducted on 121 VPS insertions (2012\u20132025) at a tertiary pediatric center in Korea. Patients were categorized into laparoscopic (n = 42) and open (n = 79) groups. The laparoscopic technique utilized only standard reusable instruments, without a peel-away sheath. Demographics, surgical parameters, postoperative recovery, and unplanned revision rates were analyzed. A Cox proportional hazards regression model was used to evaluate catheter survival, adjusting for baseline characteristics that differed significantly between the groups. Five-year shunt survival was assessed using Kaplan\u2013Meier survival analysis. Results: The laparoscopic group had more revision cases and previous abdominal surgeries; additionally, intra-abdominal adhesions were more common (52.4% vs. 3.8%), and adhesiolysis was more often performed (9.5% vs. 1.3%). However, no differences were found in total operative time, distal catheter insertion time, or perioperative complications. After adjusting for demographic differences between the groups, Cox regression analysis demonstrated no significant difference in catheter survival. Both short-term (12 months) and long-term (5 years) shunt survival rates were comparable between the groups. Conclusions: Laparoscopic VPS insertion without a peel-away sheath is feasible and safe in pediatric patients, including those with complex surgical histories. It offers favorable recovery and adhesion management outcomes without compromising shunt durability, supporting its use as a practical alternative in resource-limited settings.<\/jats:p>","DOI":"10.3390\/children13010072","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T12:23:44Z","timestamp":1767356624000},"page":"72","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic Ventriculoperitoneal Shunt Insertion Without a Peel-Away Sheath in Children: A Comparison with Conventional Open Surgery"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9540-5346","authenticated-orcid":false,"given":"Miri","family":"Ryu","sequence":"first","affiliation":[{"name":"Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"},{"name":"School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5431-959X","authenticated-orcid":false,"given":"Ayoung","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"},{"name":"School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"},{"name":"Division of Pediatric Surgery, Pusan National University Children\u2019s Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7085-5969","authenticated-orcid":false,"given":"Soo-Hong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"},{"name":"School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"},{"name":"Division of Pediatric Surgery, Pusan National University Children\u2019s Hospital, Yangsan 50612, Republic of Korea"},{"name":"Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7821-5445","authenticated-orcid":false,"given":"Jae Hun","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Surgery, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"},{"name":"School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0573-4527","authenticated-orcid":false,"given":"Hanpyo","family":"Hong","sequence":"additional","affiliation":[{"name":"Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7138-9621","authenticated-orcid":false,"given":"Soon-Ki","family":"Sung","sequence":"additional","affiliation":[{"name":"School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea"},{"name":"Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/S0140-6736(15)60694-8","article-title":"Hydrocephalus in children","volume":"387","author":"Kahle","year":"2016","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1089\/lps.1993.3.191","article-title":"Laparoscopically assisted implantation of ventriculoperito-neal shunts","volume":"3","author":"Armbruster","year":"1993","journal-title":"J. Laparoendosc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1177\/00031348211050594","article-title":"Differences in Outcome Between Open vs Laparoscopic Insertion of Ventriculoperitoneal Shunts","volume":"88","author":"Lopacinski","year":"2022","journal-title":"Am. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"382","DOI":"10.3171\/2015.6.PEDS14670","article-title":"Risk factors for shunt malfunction in pe-diatric hydrocephalus: A multicenter prospective cohort study","volume":"17","author":"Kestle","year":"2016","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1055\/s-2008-1039159","article-title":"Laparoscopic-assisted placement of ventriculo-peritoneal shunt tips in children with multi-ple previous open abdominal ventriculo-peritoneal shunt surgeries","volume":"19","author":"Johnson","year":"2009","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.jss.2021.07.045","article-title":"Just Stick a Scope in: Laparoscopic Ven-triculoperitoneal Shunt Placement in the Pediatric Reoperative Abdomen","volume":"269","author":"Sykes","year":"2022","journal-title":"J. Surg. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3171\/2011.1.JNS101492","article-title":"Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: Review of 810 consecutive cases","volume":"115","author":"Naftel","year":"2011","journal-title":"J. Neurosurg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1007\/s00381-023-05966-5","article-title":"Open versus laparoscopic ventriculoperitoneal shunt placement in children: A systematic review and meta-analysis","volume":"39","author":"Greuter","year":"2023","journal-title":"Childs Nerv. Syst."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1007\/s00464-008-0245-x","article-title":"Laparoscopic versus open ap-proach for implantation of the peritoneal catheter during ventriculoperitoneal shunt placement","volume":"23","author":"Argo","year":"2009","journal-title":"Surg. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"282","DOI":"10.3171\/PED.2008.2.10.282","article-title":"Laparoscopic placement of distal ventriculoperitoneal shunt catheters","volume":"2","author":"Handler","year":"2008","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1055\/s-0041-1739418","article-title":"Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies","volume":"32","author":"Kiblawi","year":"2022","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1097\/JU.0000000000002385","article-title":"Comparison of Cosmetic Results in Children > 10 Years Old Undergoing Open, Laparoscopic or Robotic-Assisted Pyeloplasty: A Multicentric Study","volume":"207","author":"Ghidini","year":"2022","journal-title":"J. Urol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s10143-011-0309-6","article-title":"Laparoscopy-assisted ventriculoperi-toneal shunt surgery: Personal experience and review of the literature","volume":"34","author":"Ricci","year":"2011","journal-title":"Neurosurg. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"35","DOI":"10.5005\/jp-journals-10033-1397","article-title":"Laparoscopic Intervention after Ventriculoperitoneal Shunt: A Case Report, Systematic Review, and Recommendations","volume":"13","author":"Rad","year":"2020","journal-title":"World J. Laparosc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.clineuro.2015.10.025","article-title":"Laparotomy vs minimally invasive laparoscopic ventriculoperitoneal shunt placement for hydrocephalus: A systematic review and meta-analysis","volume":"140","author":"Phan","year":"2016","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1111\/j.1471-0528.2000.tb11083.x","article-title":"The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: An assessment from the Surgical and Clinical Adhesions Re-search Study","volume":"107","author":"Lower","year":"2000","journal-title":"BJOG"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s00464-009-0569-1","article-title":"Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery","volume":"24","author":"Varela","year":"2010","journal-title":"Surg. Endosc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s00464-011-1877-9","article-title":"The ERAS protocol reduces the length of stay after laparoscopic colectomies","volume":"26","author":"Haverkamp","year":"2012","journal-title":"Surg. Endosc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"107757","DOI":"10.1016\/j.clineuro.2023.107757","article-title":"Enhanced Recovery After Surgery in Pa-tients with Normal Pressure Hydrocephalus Undergoing Ventriculoperitoneal Shunting Procedures","volume":"230","author":"Ali","year":"2023","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1053\/j.sempedsurg.2014.06.007","article-title":"Role of laparoscopy in the prevention and in the treatment of adhesions","volume":"23","author":"Anderson","year":"2014","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1097\/SLE.0b013e3181bd94f8","article-title":"Trocar site adhesions after laparoscopic surgery in children","volume":"19","author":"Nwokoma","year":"2009","journal-title":"Surg. Laparosc. Endosc. Percutan. 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