Paraumbilical Peritoneal Incision using the Little Finger in Shunt Operations for Hydrocephalus: Technical Note

Abstract

Introduction: The shunt operation remains the standard procedure for the treatment of hydrocephalus. We describe a simple minilaparotomy method that involves perforation of the peritoneum with the surgeon's little finger.

Technique: After placing a small paraumbilical incision at the skin and fascia, the little finger is introduced through the incision to perforate the pre-peritoneal fat and peritoneum. The finger should be inserted at a 30–45° angle to the horizontal plane to avoid injuring the underlying viscera and major blood vessels and to put sufficient shear force on the peritoneum. A catheter is inserted into the abdominal cavity after visual confirmation of proper perforation.

Conclusion: As the paraumbilical wound is not noticeable postoperatively due to the presence of the natural umbilical skin fold, this method yields a cosmetically appealing result.

hydrocephalus - ventriculoperitoneal shunt - lumboperitoneal shunt - peritoneum - skin incision

References

• 1 Ruse JR, McLone DG. Cerebrospinal fluid diversion procedures.. in Apuzzo MLJ (ed): Brain Surgery: Complication Avoidance and Management New York: Churchill Livingstone; 1993. Vol 2 1463-1494
• 2 Bani A, Telker D, Hassler W. et al . Minimally invasive implantation of the peritoneal catheter in ventriculoperitoneal shunt placement for hydrocephalus: Analysis of data in 151 consecutive adult patients.  J Neurosurg. 2006;  105 869-872
• 3 Kubo S, Nakata H, Yoshimine T. Peritoneal shunt tube placement performed using an endoscopic threaded imaging port.  J Neurosurg. 2001;  94 677-679
• 4 Choi SI, Lee KY, Park SJ. et al . Single port laparoscopic right hemicolectomy with D3 dissection for advanced colon cancer.  World J Gastroenterol. 2010;  16 275-278
• 5 Jeffrey RH, Kevin PL. Supraumbilical skin-fold incision for pyloromyotomy.  Am J Surg. 1996;  171 439-440

Correspondence