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.
Highlights
The National Hospital for Neurology and Neurosurgery in London is a quaternary neurosurgical unit with a specialist hydrocephalus service
A PubMed literature search was performed relating to the complications of abdominal surgery in patients with CSF-diverting shunts using the MeSH terms ‘ventriculoperitoneal shunt’, ‘lumboperitoneal shunt’, ‘CSF-diverting shunt’, ‘Laparoscopic surgery’, ‘laparoscopy’, ‘abdominal surgery’, ‘complications’, ‘infection’
Lack of awareness of the shunt tip may lead to accidental shunt transection or damage, while lack of awareness of the shunt valve may affect intraoperative CSF drainage [1]
Summary
The National Hospital for Neurology and Neurosurgery in London is a quaternary neurosurgical unit with a specialist hydrocephalus service. As a national referral unit, the hydrocephalus team receives inquiries from gastrointestinal, colorectal, urological and general surgeons from 12 hospitals in London requesting specialist advice regarding patients with CSF-diverting shunts undergoing laparoscopic or open abdominal or pelvic surgery. These frequently relate to pre-operative precautions, peri-operative considerations in shunt handling, and post-operative management of shunt-related complications. Such referrals are logged and accessed in an online database, categorising referrals by question. This article aims to provide a pragmatic overview of commonly queried pre-operative, peri-operative and post-operative considerations in these patients
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