BACKGROUND: Patients with previous abdominal surgeries are often considered unsuitable for lumboperitoneal (LP) or ventriculoperitoneal shunt placement due to the potential risk of peritoneal adhesions. This study evaluates the safety and efficacy of the lateral abdominal approach for LP shunt insertion in such patients. METHODS: A retrospective analysis was performed on 21 patients who underwent LP shunt placement for idiopathic normal pressure hydrocephalus (iNPH) via the lateral abdominal approach at our institution between January 2021 and December 2022. We reviewed patient demographics, surgical outcomes, and preoperative CT imaging to assess for abdominal adhesions and evaluate the procedure's feasibility, ensuring a thorough evaluation of the lateral abdominal approach. RESULTS: Nineteen patients were included in the final analysis, with a mean age of 72 years (36-85 years). The cohort consisted of 12 male patients and seven female patients, with a mean BMI of 24.3 kg/m². No intraoperative complications or bowel adhesions were observed during catheter placement. Preoperative CT scans showed a mean minimum distance between the peritoneum and bowel of 3.9 mm. No significant differences were found in characteristics or imaging findings between patients with and without a history of abdominal surgery. CONCLUSION: The lateral abdominal approach for LP shunt insertion has been shown to be safe and effective, even in patients with previous abdominal surgeries, as it reduces the risk of peritoneal adhesions. However, it is important to note that preoperative CT imaging alone may not be sufficient to predict adhesions. With further research and refinement, the lateral abdominal approach is valuable in treating iNPH.