Surgical technique for preventing subcutaneous migration of distal lumboperitoneal shunt catheters

The migration of lumboperitoneal shunt cathe- ters into the abdominal subcutaneous space is not uncom- mon. To prevent migration we devised a new method for installing the peritoneal tube. After catheter insertion into the lumbar spinal subarachnoid space, the tube on the peritoneal side is pulled into the areolar space between the abdominal fat and the anterior rectus sheath. A 4 cm incision is made in the sheath and the tip of the catheter is obliquely passed through the rectus abdominis muscle using a mosquito clamp. The tube is then inserted into the abdominal cavity through small openings in the posterior sheath and peritoneal membrane, located 3 cm inferior and 3 cm medial to the opening on the anterior rectus sheath. Consequently, the peritoneal tube runs obliquely, upper lateral to lower medial, through the anterior sheath, the rectus abdominis muscle, the posterior sheath, and the peritoneum. To date, we operated on 59 patients using this method. No migration of the abdominal shunt cathe- ter occurred during a follow-up period of 5.51 ± 3.6 months (mean ± standard deviation). Our technique is safe, effec- tive without migration of the peritoneal tube, and can be performed in less well-equipped operating rooms.