Cholecystectomy in patients with prior ventriculoperitoneal shunts

To assess the safety of laparoscopy in patients with CSF catheters draining distally into the abdomen

PURPOSE

This study evaluates the safety of laparoscopic procedures in patients with cerebrospinal fluid (CSF) catheters draining distally into the abdomen.

METHODS

A systematic search across PubMed, Scopus, and Ovid databases using pertinent keywords yielded 47 relevant papers, encompassing 197 cases, for analysis.

RESULTS

In the pediatric cohort (n = 129), male (49.6%) and female (34.1%) cases were reported, while gender remained unspecified in 16.3%. Shunt indications included unspecified (126 cases) and Meningomyelocele (3 cases). Laparoscopic procedures encompassed gastric (72.1%), urologic (21.7%), and other (6.2%) indications. Peri-operative shunt management included subcostal incision and clamping (1), ICP monitoring and drainage (2), and distal shunt flow confirmation (1). The prevalent complication was mechanical obstruction (10.1%), followed by pseudocyst formation (1.5%) and infection (2.3%). In the adult cohort (n = 61), males (60.6%) and females (39.3%) with a median age of 55 years were observed. Management strategies encompassed sponge packing and mobilization (11), distal shunt flow confirmation (2), shunt clamping (3), Transcranial Doppler monitoring (2), and no manipulation (30). Shunt infection emerged as the primary complication (2). Overall, 24 patients encountered VP shunt-related complications post-laparoscopy.

CONCLUSION

This study underscores the safety of laparoscopic interventions in patients with ventriculoperitoneal or lumboperitoneal shunts when facilitated by interdisciplinary cooperation. A meticulous preoperative assessment for shunt track localization, intraoperative visualization of shunt tip with CSF flow, vigilant perioperative anesthetic monitoring, and shunt dysfunction surveillance are crucial for favorable outcomes in laparoscopic procedures for these patients.

Safety of laparoscopic cholecystectomy in patients with a cerebrospinal fluid shunt in the peritoneal cavity

INTRODUCTION

The management of patients with a cerebrospinal fluid (CSF) shunt located in the peritoneal cavity undergoing laparoscopic surgery is an issue that has not yet been settled. These patients are at risk of increased intracranial pressure caused by peritoneal insufflation, shunt dysfunction, and shunt infection/retrograde meningitis. This study aimed to determine the need for perioperative shunt intervention in CSF shunt patients undergoing laparoscopic cholecystectomy.

METHODS

We reviewed and analyzed five shunt patients who underwent laparoscopic cholecystectomy in our institution between 2012 and 2022, as well as 17 patients described in previous reports.

RESULTS

Among the 22 patients, shunt type was ventriculoperitoneal in 14 and lumboperitoneal in eight. The most common indication for CSF shunt was hydrocephalus caused by cerebral vascular accident (50.0%). Laparoscopic cholecystectomy was performed for cholecystolithiasis in 13 patients (59.1%), acute cholecystitis in eight (36.4%), and gallbladder polyp in one (4.5%). Shunt clamping or externalization was performed in six patients. Two patients in the group that did not undergo shunt clamping or externalization experienced complications (intra abdominal abscess and subcutaneous emphysema). However, the incidence of short-term complications (both overall and shunt-related) and median length of hospital stay did not significantly differ between the two groups.

CONCLUSION

Routine shunt clamping, externalization, or removal might not be necessarily required in patients with a ventriculoperitoneal or lumboperitoneal shunt undergoing laparoscopic cholecystectomy.

Laparoscopy in a Patient With a Ventriculoperitoneal Shunt: A Case Report and Literature Review

Objective

This case emphasizes the safety of laparoscopy in patients with ventriculoperitoneal shunts.

Summary of background data

Previously published reports have suggested possible risks associated with laparoscopy in patients with ventriculoperitoneal shunt.

Methods

We report a case of a 17-year-old male with a ventriculoperitoneal shunt inserted 6 years ago to manage hydrocephalus that developed after surgery for medulloblastoma. The patient presented with a 5-day history of abdominal pain. He was diagnosed as having acute biliary pancreatitis. We performed laparoscopic cholecystectomy with the ventriculoperitoneal shunt in place.

Conclusion

The patient had an uneventful recovery with no shunt-related complications.

Laparoscopic bowel resection in the presence of a lumbo-peritoneal shunt: a rare case

The presence of a cerebrospinal fluid (CSF) shunt was previously considered a contra-indication to laparoscopic surgery, however, case reports appeared that describe laparoscopic surgery proceeding with no adverse outcomes in such patients. The majority of these reports relate to laparoscopic cholecystectomy. Here we present what we believe to be only the second report of a patient undergoing laparoscopic bowel resection in the presence of a lumbo-peritoneal shunt. With this case we aim to add to the evidence that more major laparoscopic procedures can be performed safely in the presence of CSF shunts and with a brief review of the current evidence, have suggested appropriate monitoring and precautionary measures for approaching these procedures.

A novel safe approach to laparoscopic colorectal cancer resection in patients with ventriculoperitoneal shunt: report of two cases and literature review

There is ongoing challenges regarding the safety of performing laparoscopic surgery with the presence of ventriculoperitoneal (VP) shunts, especially in patients treated for cancer disease. To date, only one case has been reported in the English literature. Herein, we report an additional two cases of patients with previous insertion of a VP shunt, diagnosed with colon cancer. Both our patients underwent successful laparoscopic colectomies, without clamping or removal of the VP shunt, with no reported perioperative complications or postoperative neurological deficits. Laparoscopic bowel resection for cancer, in patients with a pre-existing VP shunt, could be considered a potentially safe and feasible procedure. Furthermore, due to the increasing number of patients with VP shunts, additional case reports and investigations are warranted to further confirm safety of this procedure.

Laparoscopic Cholecystectomy for Acute Calcular Cholecystitis in a Patient with Ventriculoperitoneal Shunt: A Case Report and Literature Review

Management of patients who have ventriculoperitoneal shunt presenting with acute calcular cholecystitis has remained a clinical challenge. In this paper, the hospital course and the follow-up of a patient presenting with acute calcular cholecystitis and ventriculoperitoneal shunt managed with laparoscopic cholecystectomy are presented followed by literature review on the management of acute calcular cholecystitis in patients who have ventriculoperitoneal shunts.

Bayesian estimation of the accuracy of ICD-9-CM- and CPT-4-based algorithms to identify cholecystectomy procedures in administrative data without a reference standard

PURPOSE

To estimate the accuracy of two algorithms to identify cholecystectomy procedures using International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) and Current Procedural Terminology (CPT-4) codes in administrative data.

METHODS

Private insurer medical claims for 30 853 patients 18-64 years with an inpatient hospitalization between 2006 and 2010, as indicated by providers/facilities place of service in addition to room and board charges, were cross-classified according to the presence of codes for cholecystectomy. The accuracy of ICD-9-CM- and CPT-4-based algorithms was estimated using a Bayesian latent class model.

RESULTS

The sensitivity and specificity were 0.92 [probability interval (PI): 0.92, 0.92] and 0.99 (PI: 0.97, 0.99) for ICD-9-CM-, and 0.93 (PI: 0.92, 0.93) and 0.99 (PI: 0.97, 0.99) for CPT-4-based algorithms, respectively. The parallel-joint scheme, where positivity of either algorithm was considered a positive outcome, yielded a sensitivity and specificity of 0.99 (PI: 0.99, 0.99) and 0.97 (PI: 0.95, 0.99), respectively.

CONCLUSIONS

Both ICD-9-CM- and CPT-4-based algorithms had high sensitivity to identify cholecystectomy procedures in administrative data when used individually and especially in a parallel-joint approach.

Ventriculoperitoneal shunt and the need to remove a gallbladder: Time to definitely overcome the feeling that laparoscopic surgery is contraindicated

Since Baskin et al. reported the first documented case of failure of a laparoscopically-induced ventriculoperitoneal shunt (VP) in 1998, the cerebrospinal fluid shunt has been generally considered a relative contraindication to laparoscopy. Although the literature is limited there is a small body of evidence indicating that it is safe to perform laparoscopic surgery on these patients with routine anaesthetic monitoring. In this study we report the case of a laparoscopic cholecystectomy in the presence of a ventriculoperitoneal shunt. A review of the literature suggests that laparoscopic cholecystectomy can be safely performed in patients with a ventriculoperitoneal shunt. The only related contraindication should be if a catheter has recently been placed.

[Laparoscopic cholecystectomy in a patient with ventriculoperitoneal shunt system]

BACKGROUND

Pediatric patients with hydrocephalus and ventriculoperitoneal (VP) shunt systems are not exempt from suffering from gastrointestinal diseases. Today, with technological advances it would be controversial to not offer the benefits of minimally invasive surgery. To date, no studies have been carried out comparing different techniques to assess the best way to prevent intracranial hypertension. However, there are increasing reports of safe surgery in children with VP shunt operated by laparoscopy.

CASE REPORT

We present the case of a 14-year-old male who presented for laparoscopic cholecystectomy with a VP shunt system. The patient had clinical data of cholecystitis; therefore, it was decided to perform laparoscopic cholecystectomy. The patient experienced a satisfactory evolution with hospital discharge at 72h postoperatively.

CONCLUSIONS

Currently, it is common that children with hydrocephalus and VP systems may require some type of laparoscopic surgery. This surgery is safe for various procedures including gallbladder and ovarian pathology. Satisfactory results will help the surgeon make a better surgical decision in this type of pediatric patient.

Laparoscopic cholecystectomy in the presence of lumboperitoneal shunt

Laparoscopic cholecystectomy remains the mainstay of treatment in patients with gallstone disease. Nowadays more than ever before, patients present with more comorbidities and entities that make the laparoscopic approach composite. One of these is the presence of lumboperitoneal (LP) shunts. Herein, we describe a case of successful laparoscopic cholecystectomy in a patient with an LP shunt and an occipital nerve stimulator in the anterior abdominal wall. We describe alterations in technique, aiming at surgeons that perform laparoscopic cholecystectomies with useful tips in order to successfully deliver the operation. A brief review of the literature in the current subject is also given.

Laparoscopic cecal cancer resection in a patient with a ventriculoperitoneal shunt: A case report

INTRODUCTION

The presence of a ventriculoperitoneal shunt has been considered to be a contraindication for laparoscopic surgery till date; however, laparoscopic cholecystectomy was recently reported as safe for patients with this shunt.

PRESENTATION OF CASE

We present the first case, to the best of our knowledge, of laparoscopic colectomy for cecal cancer in a patient with a ventriculoperitoneal shunt. A 59-year-old woman with a ventriculoperitoneal shunt for hydrocephalus was referred to our hospital with cecal cancer. Laparoscopic cecal cancer resection was performed successfully and uneventfully by manipulating the shunt.

DISCUSSION

Clamping of the shunt catheter at the subcutaneous region was performed before insufflation of carbon dioxide to prevent adverse effects from the pneumoperitoneum.

CONCLUSION

We believe that laparoscopic colectomy for colon cancer can be performed safely in patients with a ventriculoperitoneal shunt by optimal manipulation of the shunt.

Chronically symptomatic patients with undetectable gall bladder on ultrasonography could benefit from early cholecystectomy

90 percent of symptomatic patients undergoing cholecystectomy have cholelithiasis with 10% categorized as asymptomatic cholecystitis. In both instances, the gallbladder is evident on ultrasonography. In children with symptomatic biliary dyspepsia, the decision to proceed to cholecystectomy is made difficult if choleliths are not seen on ultrasonography. This decision is made even more difficult if the gallbladder itself is not seen on repeated imaging. In a cohort of 54 cholecystectomies, 3 cases, with recurrent right upper quadrant pain and undetectable gallbladders on repeat ultrasonography, were identified. After prolonged observation all underwent successful cholecystectomy. Histology demonstrated a markedly fibrotic and thickened gallbladder in all. Given this experience, we suggest that nonvisibility of the gallbladder, in fact, maybe be a feature of a chronic acalculous cholecystitis. We advise consideration of cholecystectomy for chronic biliary dyspepsia where repeat ultrasonography fails to demonstrate a gallbladder.

Laparoscopic fundoplication in children with ventriculo-peritoneal shunts

BACKGROUND

Children with ventriculo-peritoneal (V-P) shunts have a significant risk of morbidity and mortality from infections. Many of these patients have other co-morbidities and may require subsequent abdominal surgery, including fundoplication with or without gastrostomy placement. The aim of our study was to assess the outcomes of laparoscopic fundoplication in children with a V-P shunt in situ.

SUBJECTS AND METHODS

A retrospective review of a prospectively maintained database on children who underwent laparoscopic fundoplication with a V-P shunt in situ at the time of surgery between July 1998 and March 2011 was conducted. Primary outcomes included intra- and postoperative complications as well as shunt-related problems within a 6-month period after surgery. The subset of children with V-P shunts was compared with those who underwent fundoplication without shunts. Variables were compared using the two-tailed Student's t test, chi-squared test, or Fisher's exact test. Significance was defined as P≤.05.

RESULTS

Out of a total of 343 children who underwent fundoplication, 11 (6 girls, 5 boys) had a V-P shunt in situ at the time of surgery (3.2%). The median age at laparoscopy was 2.2 years (range, 0.7-13.8 years). Weight at surgery ranged from 5.8 to 39.0 kg (median, 12.0 kg). The operating time (without gastrostomy placement) was 105 minutes (range, 80-140 minutes). In 6 patients (55%) moderate to severe adhesions were documented, but only 1 child required conversion to open surgery because of bleeding from the omentum. In a second patient the colon was perforated during insertion of the percutaneous endoscopic gastrostomy (PEG) and repaired laparoscopically. There was no postoperative shunt dysfunction or infection related to the laparoscopic procedure. There was no significant difference between V-P shunt patients and the main cohort regarding operating time, conversion to open surgery, need for admission to a high-care unit, opiate requirements, time to full feeds, and length of hospital stay.

CONCLUSIONS

These data suggest that laparoscopic fundoplication is feasible in children with previous V-P shunt placement. Although there were considerable adhesions in approximately half of these patients, the rate for conversion to open surgery was low. Complications associated with simultaneous PEG insertion occur and should be anticipated by placing the gastrostomy under laparoscopic guidance.