Recommended Citation
Rao Shuai I, Aghajani K, Gaiha R, Knezevic N. Considerations for laparoscopic gastrectomy in a patient with lumboperitoneal shunt. Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Presentation Notes
Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Abstract
Introduction: One relative contraindication of laparoscopic surgery is patients having a cerebrospinal fluid (CSF) shunt that drains into the peritoneum due to reports of perioperative shunt complications. These complications include intracranial hypertension due to reversed flow of CSF, shunt failure, and emphysema along the shunt trajectory. However, due to ongoing improvements of these CSF shunts, recent data suggests that laparoscopic surgeries are safe to proceed with special considerations.[1] There are no major studies or reviews standardizing practices regarding patients with CSF shunts. Case Presentation: A 49 years old female with a past medical history significant for recurrent headaches, obesity class III, Chiari malformation and pseudo tumori cerebra status post decompression and lumboperitoneal (LP) shunt placement in 2015 with multiple revisions presented for a laparoscopic sleeve gastrectomy in October 2023. She has an LP shunt with Certas valve and gravity compensating accessory. The patient has had multiple revisions in the past due to shunt malfunctions, where her symptoms include postural headache and dysarthria. The catheter is placed in thecal sac at L3-L4 level and the distal tip into the peritoneal cavity. Intraoperatively, the pneumoperitoneum was set at 10cm H2O instead of 15cm H2O. The catheter was not clamped during the surgery and no additional antibiotics were given. After the case, the patient did not report headache, dysarthria or any neurological deficit. Conclusion: Our case exemplifies some of the measures that can be used for laparoscopic surgeries in patients with CSF shunt. Upon reviewing a few examples in the literature [1-2], we concluded that elective laparoscopic surgeries can be done in patients with VP shunts with valve without clamping the shunt and without additional antibiotics. Recommendations are consult with Neurosurgery regarding the type of valve used by the patient, try to keep insufflation < 3 hours and use of standard ASA monitorization.[1-2] If there is high risk of elevated intracranial pressures, there are noninvasive intracranial pressure monitorization such as optic nerve sheath diameter or transcranial doppler.[3] Patients must be closely monitored for neurological symptoms in the PACU. More systematic reviews and studies are needed to determine the optimal insufflation pressure for laparoscopies. 1. Cobianchi, lorenzo. (2014) Ann Med Surg 3: 65-67. 2. Yoshihara T, Tomimaru Y. (2017) Asian J Endosc Surg 10(4):394–398. 3. Robba, C. (2015) J Clin Monit Comput 30: 527-538.
Type
Oral/Podium Presentation