Operative Management of Ventriculoperitoneal Shunts during Bariatric Operations

Abstract

Background: Idiopathic intracranial hypertension is a condition associated with morbid obesity. Although bariatric surgery offers an effective treatment, some bariatric surgical candidates will present with indwelling ventriculoperitoneal (VP) shunts. The maintenance of shunt sterility is paramount. Objective: To review our experience with a regimen of VP shunt externalization, in patients undergoing primary bariatric procedures. Setting: Academic university hospital Methods: Records of all patients who underwent bariatric procedures between 4/1/2004 and 11/1/2007 were reviewed. Our protocol was to externalize all shunts at the beginning, for patients undergoing Roux-en-Y gastric bypasses (RYGB), and to leave all shunts externalized for one week; shunts were re-internalized at a subsequent procedure if no signs of infection were present. Laparoscopic adjustable gastric banding (LAGB) patients would have the shunt evaluated simultaneously and left in place if functional. Results: Of the 1,759 patients who underwent bariatric procedures from 2004 to 2007, six had indwelling VP shunt. Four patients underwent laparoscopic RYGB, 1an open RYGB, and one patient underwent LAGB with the same VP shunt management protocol. All patients had their shunts re-internalized without sequelae, with the exception of one patient who was no longer shunt dependent. One patient did have migration outside of the abdominal wall by the shunt; to prevent migration, the shunt was fixed to a section of prolene mesh. No patients developed evidence of contamination. Conclusions: The technique of VP shunt externalization may be a safe and effective technique of managing VP shunt during bariatric surgical procedures.