Page 40 - World Journal of Laparoscopic Surgery

Laparoscopic Intervention after VP Shunt

Flowchart 1: Flowchart of articles during the review process

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the ICP intraoperatively, and perioperative strategies to avoid Baskin et al. described the first documented case of
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complications. laparoscopically induced VP shunt failure in 1998. Postoperatively,
the patient’s condition was not improving, and he was experiencing
Reported Cases, Complications, and Technical intermittent apnea. He had to be re-intubated. An urgent head
Difficulties CT that the patient underwent shortly after experiencing the
The pressure used for the pneumoperitoneum was between symptoms demonstrated a ventriculomegaly with no evidence
8 mm Hg and 50 mm Hg, mostly 12 mm Hg. 1,2,8,10,17,19–37,39,40 of intracranial hemorrhage or pneumocephalus. The patient was
The following complications occurred: one case of massive indicated for another surgery. Intraoperatively, an isolated distal
subcutaneous emphysema, 11 cases of conversion to laparotomy shunt obstruction was detected. A gentle irrigation cleared the
due to extensive inflammation, gangrenous situation, 10,20 a large occlusion. The authors believe that this shunt dysfunction occurred
tumor, and adhesions. 21,36 One case of shunt failure directly after as a result of the peritoneal insufflation.
10
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the operation, eight cases of postoperative VP shunt removal or Allam et al. conducted a chart review of 23 patients from
revision due to infection, 1,2,8,10 one case of multiple organ failure 1994 to 2003 in the USA and reported a 57% rate of conversion to
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and death, and one case of pneumocephalus. 36 an open procedure, which was attributed to dense adhesion. Two
Two cases of cancer with the VP shunt were reported, one patients required a shunt removal and replacement caused by a
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prostatectomy in prostate cancer, and one colectomy in cecal postoperative shunt infection. It has been documented that those
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cancer. In all the cases the traditional laparoscopy was used, two patients did not receive prophylactic antibiotics perioperatively.
except for one where robotic hysterectomy was carried out. 33 The rest of the patients was administered antibiotics pre-, intra, or
The first reported case of laparoscopic surgery having postoperatively.
19
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complications with a VP shunt was described by Schwed et al. Raskin et al. demonstrated a case of a 24-year-old female who
They reported a 73-year-old woman who underwent a laparoscopic had a VP shunt for more than 20 years, in 2011. She was diagnosed
cholecystectomy 10 days after the insertion of a VP shunt. She with endometriosis and underwent a laparoscopic bilateral
suffered subcutaneous emphysema and impaired respiratory salpingo-oophorectomy with the abdominal pressure of 50 mm
condition directly after the procedure. The patient recovered Hg. The procedure was converted to an open laparotomy due to
uneventfully with no evidence of postoperative infection. 19 significant abdominal adhesions.
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Collure et al. observed one case of multiple organ failure, of Approximately 1 week after the surgery, the patient presented
a group of four patients, after a laparoscopic operation. A patient with increased agitation and abdominal distension. A CT of the
with multimorbidities received a laparoscopic cholecystectomy pelvis revealed an abscess requiring a placement of a pelvic drain
to reduce the surgical trauma and the long recovery phase that and a VP shunt externalization. A head CT prior to the shunt removal
follows an open procedure. The postoperative period for this showed a pneumocephalus with air to be seen within the shunt
patient was complicated by lobar pneumonia, which progressed valve. 36
into multiorgan failure and the patient died. 20
21
Tobias et al. reported the first gynecological case in 1996. Monitoring of the ICP Intraoperatively/Protecting
They did a safe diagnostic laparoscopy with a pneumoperitoneum Techniques
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pressure of 15 mm Hg in a patient with a pelvic tumor. The operation The first monitoring was reported by Collure et al. who
was converted to laparotomy due to adhesions and the size of the documented the ongoing flow of the CSF in vivo in VP shunts with
tumor. 21 the pneumoperitoneum pressure of 10 to 15 mm Hg. 20

38 World Journal of Laparoscopic Surgery, Volume 13 Issue 1 (January–April 2020)