2005
DOI: 10.1097/01.sle.0000153733.78227.8f
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Laparoscopic Procedures in Adults With Ventriculoperitoneal Shunts

Abstract: Until recently, the presence of a ventriculoperitoneal shunt (VPS) was considered an absolute contraindication to laparoscopy. In some cases, intraabdominal insufflation causes a rapid, sustained increase in intracranial pressure (ICP). Such intracranial hypertension may result in hindbrain herniation. To prevent this, the use of lower abdominal pressures, intraoperative ICP monitoring, intraoperative ventricular drainage, and distal shunt catheter clamping/externalization has been reported in some studies. Ho… Show more

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Cited by 33 publications
(25 citation statements)
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“…Laparoscopic cholecystectomy, gastrostomy, fundoplication, Ladd's procedure, and many urologic procedures all have been demonstrated to be safe without evidence of neurologic complication and low rates of infection. [11][12][13][14][15][16] In a recent comparative series, there was a higher rate of VP shunt infections in pediatric patients who underwent open (7 infections), as opposed to laparoscopic (3 infections), Nissen fundoplications=gastrostomy tubes. 17 In our study, there were 3 infections in the open group and 1 in the laparoscopic group; the difference did not reach statistical significance.…”
Section: Discussionmentioning
confidence: 96%
“…Laparoscopic cholecystectomy, gastrostomy, fundoplication, Ladd's procedure, and many urologic procedures all have been demonstrated to be safe without evidence of neurologic complication and low rates of infection. [11][12][13][14][15][16] In a recent comparative series, there was a higher rate of VP shunt infections in pediatric patients who underwent open (7 infections), as opposed to laparoscopic (3 infections), Nissen fundoplications=gastrostomy tubes. 17 In our study, there were 3 infections in the open group and 1 in the laparoscopic group; the difference did not reach statistical significance.…”
Section: Discussionmentioning
confidence: 96%
“…Retrograde insufflation of CSF in the presence of an incompetent shunt valve and distal catheter obstruction from soft tissue during creation of pneumoperitoneum can also contribute to the potential increase in ICP. 4 Many suggestions have been introduced to prevent increase in ICP; the use of lesser abdominal pressure, intra operative ICP monitoring/ventricular drainage and distal shunt catheter clamping/externalization. 4,5 These methods however have not been used routinely, and laparoscopic cholecystectomy was reported to be performed successfully without the need for any modification in intra-abdominal pressure or shunt manipulation.…”
Section: Discussionmentioning
confidence: 99%
“…4 Many suggestions have been introduced to prevent increase in ICP; the use of lesser abdominal pressure, intra operative ICP monitoring/ventricular drainage and distal shunt catheter clamping/externalization. 4,5 These methods however have not been used routinely, and laparoscopic cholecystectomy was reported to be performed successfully without the need for any modification in intra-abdominal pressure or shunt manipulation. 3 Furthermore, the potential serious side effects associated with invasive ICP monitoring, like intracranial haemorrhage, far outweighs the risk of adverse effects.…”
Section: Discussionmentioning
confidence: 99%
“…Modern VPS systems are extremely safe as they have a one-way valve and can withstand high intraabdominal pressures 1,4 . Laparoscopic procedures were reported safe in patients with VPS and generally requires monitoring limited to clinical observation 3 . But there can still be a possibility of a shunt failure in certain patients having a prior VPS with unascertained characteristics.…”
mentioning
confidence: 99%
“…In these patients, laparoscopic approach has definite advantages, which include the lesser formation of intra-abdominal adhesions and limited skin-to-shunt contact, leading to minimum risk of shunt infection and shunt revision 1 . But there can still be a possibility of acute shunt dysfunction owing to pneumoperitoneum creation such as distal catheter obstruction by soft tissue impaction and failure of a valve system 2,3 . This eventually causes retrograde insufflation of cerebrospinal fluid (CSF) and carbon dioxide diffusion through the distal end of the catheter, generating a risk of rapid and sustained elevation of intracranial pressure (ICP) [2][3][4] .…”
mentioning
confidence: 99%