Feasibility of laparoscopic cholecystectomy in patients with cerebrospinal fluid shunt.

Abstract

Previous reports of laparoscopic surgery in patients with cerebrospinal fluid (CSF) shunts for intracranial hypertension described shunt-related complications. Thus, the shunts have been considered a contraindication for laparoscopic procedures. However, with the implementation of recent improvements in surgical techniques, perioperative management, and shunt technology, laparoscopic surgery may now be safe in cases with shunts. The aim of the present study was to examine the safety of such procedures based on our own experiences with laparoscopic surgery in patients with CSF shunts. A total of 582 patients underwent laparoscopic cholecystectomy for gallbladder disease at our institute during the study period. Among these patients, four (0.7%) had a CSF shunt at the time of laparoscopic cholecystectomy. We retrospectively investigated the clinical characteristics of these four cases. Two patients had ventriculoperitoneal shunts, and two patients had lumboperitoneal shunts. Based on the advice of consulted neurosurgeons, the shunt catheter was clamped during pneumoperitoneum in three of the four cases, and the catheter was left unclamped in the remaining case because it was judged to be occluded. Laparoscopic cholecystectomy was performed under pneumoperitoneum pressure of 8 mmHg. All four cases experienced an uneventful postoperative course, with no shunt-associated complications. Analysis of our current cases suggests the safety of laparoscopic cholecystectomy in cases with CSF shunts.