腹腔鏡下低位前方切除術における腹腔シャント患者の症例報告

Hydrocephalus is commonly managed with a ventriculoperitoneal (VP) shunt, and the safety of laparoscopic surgery in these patients remains debated due to concerns regarding shunt malfunction and altered intracranial pressure. Evidence is mostly pediatric, with limited adult data. We report a case of laparoscopic low anterior resection (LAR) in an adult with a VP shunt. A 70-year-old man with a VP shunt placed 10 years prior was diagnosed with a well-differentiated rectosigmoid adenocarcinoma without metastasis. He underwent laparoscopic LAR using low insufflation pressure and intermittent desufflation. The shunt was left unclamped. The procedure was uneventful, and he was discharged on postoperative Day 4 with no neurological or surgical complications. Although historically considered high-risk, current evidence suggests that laparoscopic surgery can be safely performed in patients with VP shunts when careful perioperative measures are taken. Laparoscopic colon resection appears safe in selected VP shunt patients when appropriate precautions are implemented.