Laparoscopic Ventriculoperitoneal Shunt Insertion Without a Peel-Away Sheath in Children: A Comparison with Conventional Open Surgery

<b>Background/Objectives</b>: 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. <b>Methods</b>: A retrospective review was conducted on 121 VPS insertions (2012-2025) at a tertiary pediatric center in Korea. Patients were categorized into laparoscopic (<i>n</i> = 42) and open (<i>n</i> = 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-Meier survival analysis. <b>Results</b>: 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. <b>Conclusions</b>: 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.