Page 37 - World Journal of Laparoscopic Surgery

REVIEW ARTICLE
Laparoscopic Intervention after Ventriculoperitoneal Shunt: A

Case Report, Systematic Review, and Recommendations

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Morva Tahmasbi Rad , Sandra Bogdanyova , Lisa M Wilhelm , Juergen Konczalla , Florian J Raimann , Markus Wallwiener ,
Sven Becker 7
AbstrAct
Background: In patients presenting pelvic pathology and a placed ventriculoperitoneal (VP) shunt, there is uncertainty regarding the decision
whether to use laparoscopy. The aim of the article is to examine the available literature as well as sharing our own experiences operating on a
patient with a VP shunt using laparoscopy.
Materials and methods: We searched online libraries (PubMed, EMBASE, and Google Scholar) for all publications published between January
1975 and December 2018 on our topic. We performed a systematic review and shared our experience with laparoscopy in a patient with shunt
and ovarian cancer.
Results: The age of the patients ranged from 1 to 79 years. The operations were performed by the departments of general surgery, gynecology,
and urology. The time from the shunt operation to laparoscopy ranged from 5 days to 28 years. In different articles, four important points were
considered and discussed: the risk of a shunt infection or complication, technical difficulties carrying out laparoscopy in patients with a VP
shunt, the necessity of routine monitoring of the intracranial pressure (ICP) intraoperatively, and perioperative strategies to avoid complications.
Conclusion: It seems that a laparoscopic surgery in adults with a VP shunt appears to be a safe option. Based on the results of our case and the
review of literature, we consider it necessary to have a neurosurgical consult performed prior to surgery, to have the procedure be carried out
by an experienced surgeon, and to avoid complications by implementing recommended precautions.
Keywords: Complication, Laparoscopy, Shunt failure, Ventriculoperitoneal shunt.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1397

IntroductIon 1–3,7 Department of Obstetrics and Gynecology, University of Frankfurt,
Frankfurt am Main, Germany
The approach to abdominal procedures has transitioned toward less 4
invasive techniques. The reduction in postoperative pain, decreases Department of Neurosurgery, University of Frankfurt, Frankfurt am
in wound infection, reduced hospital stay and cosmetic benefits Main, Germany
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have warranted its widespread use. With its increased use, surgeons Department of Anesthesiology, University of Frankfurt, Frankfurt am
are presented with a group of patients whose medical conditions Main, Germany
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are a challenge when performing laparoscopic surgery. Patients Department of Obstetrics and Gynecology, University of Heidelberg,
treated with a VP shunt represent such a group. 1 Heidelberg, Germany
Shunting is the most common treatment of hydrocephalus. Corresponding Author: Morva Tahmasbi Rad, Department of
Across all age-groups, the prevalence of hydrocephalus is estimated Obstetrics and Gynecology, University of Frankfurt, Frankfurt am Main,
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at 1.0 to 1.5% and about 100,000 shunts are implanted each year in Germany, Phone: +49-6301-5115, e-mail: Morva.TahmasbiRad@kgu.de
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the developed countries. Hydrocephalus has different etiologies, How to cite this article: Rad MT, Bogdanyova S, Wilhelm LM, et al.
including malformations, agenesis, infections, mass lesions (tumors, Laparoscopic Intervention after Ventriculoperitoneal Shunt: A Case
hematomas, cysts, and abscesses), head trauma, and hemorrhages. Report, Systematic Review, and Recommendations. World J Lap Surg
2020;13(1):35–42.
A VP shunt is a mechanical device designed to transport the excess
cerebrospinal fluid (CSF) from or near the point of obstruction to a Source of support: Nil
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reabsorption site and is implanted subcutaneously. The absorption Conflict of interest: None
site is usually the abdomen (peritoneum). The valve and reservoir
control the fluid withdrawn from the brain. The distal end is a
small narrow piece of tubing which leads the excess CSF into the in the intrathoracic pressure during coughing or intra-abdominal
peritoneum (Figs 1 and 2). The unidirectionally designed valve is pressure, for example, Valsalva maneuver or communication with
necessary to prevent the reflux of CSF and intra-abdominal fluid. the vascular system (venous and arterial). The ICP at 20 to 25 mm
It allows the fluid to flow only when the pressure inside the skull Hg, which is the upper limit of the norm, may require treatment to
has exceeded a certain value (usually referred to as the “opening reduce the ICP. When the ICP exceeds 40 to 50 mm Hg, the cerebral
pressure”). 3,4 perfusion decreases to a level causing loss of consciousness and
The ICP (pressure inside the skull), is normally 7 to 15 mm Hg at leading to infarction or brain dead.
rest for a mature adult in the supine position. This varies by about A rise in the ICP is a result of a pressure rise in the vena cava when
1 mm Hg caused by shifting in the production and absorption of insufflating the abdomen with CO , and this leads to an obstruction
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CSF. The CSF pressure is shown to be influenced by abrupt changes of the cerebral veins. Hypercapnia caused by the absorption of

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