Laparoscopic procedures in adults with ventriculoperitoneal shunts

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. However, other studies show that laparoscopy is safe even without VPS catheter clamping and with only routine anesthetic monitoring. Moreover, the risk of retrograde failure of the valve system has been shown to be minimal even with intraabdominal pressures as high as 80 mm Hg. We report how we managed a hydrocephalic adult with a VPS shunt undergoing laparoscopic cholecystectomy in the hope that our experience contributes to the successful management of such patients in the future.