Laparoscopic cholecystectomy in the presence of lumboperitoneal shunt

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.

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.

CSF-diverting shunts: Implications for abdominal and pelvic surgeons; a review and pragmatic overview

The optimal management of patients with ventriculoperitoneal or lumboperitoneal shunts undergoing abdominal or pelvic surgery for unrelated reasons is often unclear due to the paucity of guidelines in this field. In this review, we outline key issues in managing these patients. Specifically, we address issues relating to pre-operative planning, avoidance of shunt-related complications such as infection and malfunction, and specific management of neurological symptoms in the post-operative period. A retrospective study was carried out analysing correspondence between general surgeons and a specialist hydrocephalus unit over a 4-year period relating to management of patients with ventriculoperitoneal and lumboperitoneal shunts undergoing abdominal or pelvic surgery. A literature review was carried out to identify available evidence in this field. 30 queries from general surgeons were identified comprising 12 main themes. 16 relevant publications were identified. We summarised these to answer these queries. The management of shunted patients may present challenges and uncertainties in an abdominal or pelvic surgery setting. This paper provides guidelines and clarity in this field by discussing and summarising reported data in the literature.

Laparoscopic Resection of Advanced Colorectal Cancer in a Patient with Lumboperitoneal Shunt

A 78-year-old woman with lumboperitoneal (LP) shunt was diagnosed with advanced cancer of the ascending colon. Laparoscopic right hemicolectomy was performed without manipulating the catheter. The patient's postoperative course was uneventful, with no shunt-related complications or neurological deficit. The number of patients with cerebrospinal fluid (CSF) shunt who require abdominal surgery has been increasing. There are only few studies on laparoscopic surgery for patients with LP shunt, and the safety of pneumoperitoneum in the CSF shunt remains controversial. Consistent with other studies, we considered that pneumoperitoneum with a pressure of 10 mmHg has few negative effects. Our recommendations are as follows: (1) during colorectal resection, laparoscopic surgery can be performed without routine manipulation of the shunt catheter; (2) altering the location of the port is necessary to prevent both damage to the shunt tube during surgery and wound infection postoperatively; and (3) laparoscopic surgery is superior to laparotomy because it is associated with reduced surgical site infections and postoperative adhesions. However, laparoscopy should be performed at least 3 months after the construction of CSF shunt.

Laparoscopic umbilical hernia repair in a cirrhotic patient with a peritoneovenous shunt

A 62-year-old Japanese woman who had developed massive cirrhotic ascites was referred to our hospital for a peritoneovenous shunt implant. However, CT examination revealed an umbilical hernia that had not been observed before the peritoneovenous shunt was implanted. We decided to perform laparoscopic umbilical hernia repair to keep carbon dioxide from flowing backward into the central circulatory system. We first clamped the catheter and set the upper limit of the pneumoperitoneum pressure to 6 mmHg. The central venous pressure was also measured simultaneously. Mesh was then applied over the hernia and fixed by the double-crown technique. Finally, 1000-mL physiological saline was infused into the abdominal cavity while the pneumoperitoneum was slowly released. In this case, we safely performed laparoscopic umbilical hernia repair while making some alterations, specifically catheter clamping, reducing pneumoperitoneum pressure, monitoring central venous pressure, and infusing physiological saline.