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

Abstract

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.

Lumboperitoneal shunt surgery via continuous two-stage procedure: Technique notes and outcomes

“…However, laparoscopic-assisted laparotomy usually requires participation by an abdominal surgeon, and this may be a problem in some institutes. Besides, although increased abdominal pressure during laparoscopic surgery usually does not affect ICP or the CSF shunt system in the presence of a working unidirectional valve, it should be a concern when the hydrocephalus is highly shunt-dependent ( 14 ). Goto et al described lateral abdominal laparotomy, excluding laparoscopic-assisted laparotomy ( 6 ).…”

Feasibility of Nonintubated Anesthesia for Lumboperitoneal Shunt Implantation

“…Traditionally, the placement of the peritoneal catheter is completed by neurosurgeons through a mini-laparotomy incision. The potential complications of this procedure include visceral injury, subsequent abdominal hernia, wound infection, inadvertent subcutaneous placement, disconnection, and shunt obstruction [ 10 , 11 , 12 ]. Under nonintubated anesthesia, the difficulty of mini-laparotomy when patients have spontaneous breathing during the surgery should be overcome.…”

Laparoscopic Hysterectomy in a Patient with Ventriculo-Peritoneal Shunt after Multiple Cesarean Sections

“…Baskin, et al recorded the first case of failure of VPS following laparoscopic procedure where the patient operations. Internalization of the distal shunt catheter would then be performed after a liaison with a neurosurgeon, and some patients may need an alternative destination as ventriculo-atrial and ventriculo-pleural shunts [14].…”