Iberoamerican Journal of Medicine
Iberoamerican Journal of Medicine

Safety of Laparoscopy in Patients with Ventriculoperitoneal Shunts

Sarah A. Mohamed, Abbas AR Mohamed

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The relationship between the intra-abdominal pressure (IAP) and intracranial pressure (ICP) has been suspected for more than 100 years and was subsequently confirmed by numerous studies in both animals and humans which demonstrate the link and the positive correlation between IAP and ICP.
There are mounting concerns that the pneumoperitoneum created during laparoscopic surgery to create space for instrument placement and to allow safe tissue dissection may result in an increase in the ICP secondary to the increase in the IAP which may result in serious consequences in patients with Ventriculoperitoneal (VP) shunts.
There is uncertainty about the safety of laparoscopic surgery in VP shunt patients. The aim of this article is to review the literature to answer the question [Is laparoscopic surgery safe in VP shunt patients with and without intraoperative monitoring of ICP]?


Laparoscopy; Surgery; Ventriculoperitoneal shunts; Safety


1. Jackson IJ. A review of the surgical treatment of internal hydrocephalus. J Pediatr. 1951;38(2):251-8. doi: 10.1016/s0022-3476(51)80117-3.
2. Alexander E Jr. Archaeology: the big neurosurgical dig. Clin Neurosurg.;28:323-73. doi: 10.1093/neurosurgery/28.cn_suppl_1.323.
3. Lau WY, Leow CK, Li AK. History of endoscopic and laparoscopic surgery. World J Surg. 1997;21(4):444-53. doi: 10.1007/pl00012268.
4. Stellato TA. History of laparoscopic surgery. Surg Clin North Am. 1992;72(5):997-1002. doi: 10.1016/s0039-6109(16)45826-3.
5. Goodrich JT. History of Hydrocephalus and Its Surgical Treatment. In: Cinalli G., Ozek M., Sainte-Rose C, editors. Pediatric Hydrocephalus. Springer. 2018:1-45. doi: 10.1007/978-3-319-31889-9_34-1.
6. Scarff JE. Treatment of hydrocephalus: an historical and critical review of methods and results. J Neurol Neurosurg Psychiatry. 1963;26(1):1-26. doi: 10.1136/jnnp.26.1.1.
7. Rachel RA. Surgical treatment of hydrocephalus: a historical perspective. Pediatr Neurosurg. 1999;30(6):296-304. doi: 10.1159/000028814.
8. Corsello A, Di Dalmazi G, Pani F, Chalan P, Salvatori R, Caturegli P. Walter E. Dandy: his contributions to pituitary surgery in the context of the overall Johns Hopkins Hospital experience. Pituitary. 2017;20(6):683-91. doi: 10.1007/s11102-017-0834-6.
9. Dandy WE, Blackfan KD. Internal hydrocephalus: A clinical and pathological study. Am J Dis Child. 1914;VIII(6):406-82. doi:10.1001/archpedi.1914.02180010416002.
10. Keen WW. Surgery of the lateral ventricles of the brain. Lancet. 1890;136(3498):553-5. doi: 10.1016/S0140-6736(00)48676-9.
11. Srinivasan VM, O'Neill BR, Jho D, Whiting DM, Oh MY. The history of external ventricular drainage. J Neurosurg. 2014;120(1):228-36. doi: 10.3171/2013.6.JNS121577.
12. Davidoff LM. Treatment of hydrocephalus: Historical review and description of a new method. Arch Surg. 1929;18(4):1737-62. doi:10.1001/archsurg.1929.01140130837055.
13. Weisenberg SH, TerMaath SC, Seaver CE, Killeffer JA. Ventricular catheter development: past, present, and future. J Neurosurg. 2016;125(6):1504-12. doi: 10.3171/2015.12.JNS151181.
14. Sylvia K. Sylvia K: AdvaMed Combination Products Workshop Case Study–Antibacterial Orthopedic and Neurological Devices. Available from: http://www.fda.gov.tw/upload/189/Content/2013011112025251410.pdf (accessed Feb 2021).
15. Drake JM, Rose CS. The Shunt Book: New York:Wiley; 1995.
16. Vecchio R, MacFayden BV, Palazzo F. History of laparoscopic surgery. Panminerva Med. 2000;42(1):87-90.
17. Litynski GS. Highlights in the History of Laparoscopy: the Development of Laparoscopic Techniques-a Cumulative. Effort of Internists, Gynecologists and Surgeons. Frankfurt: Barbara Bern-ert Verlag; 1996.
18. Nezhat C, Page B. Let There Be Light: a Historical Analysis of Endoscopy's Ascension since Antiquity. Available from: http://sls.org/nezhats-history-of-endoscopy/ (accessed Feb 2021).
19. Kaiser AM, Corman ML. History of laparoscopy. Surg Oncol Clin N Am. 2001;10(3):483-92.
20. Kelley WE Jr. The evolution of laparoscopy and the revolution in surgery in the decade of the 1990s. JSLS. 2008;12(4):351-7.
21. Périssat J, Collet D, Monguillon N. Advances in laparoscopic surgery. Digestion. 1998;59(5):606-18. doi: 10.1159/000007535.
22. Berci G, Davids J. Endoscopy and television. Br Med J. 1962;1(5292):1610-3. doi: 10.1136/bmj.1.5292.1610.
23. Dubois F, Icard P, Berthelot G, Levard H. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg. 1990;211(1):60-2. doi: 10.1097/00000658-199001000-00010.
24. Depauw PRAM, Groen RJM, Van Loon J, Peul WC, Malbrain MLNG, De Waele JJ. The significance of intra-abdominal pressure in neurosurgery and neurological diseases: a narrative review and a conceptual proposal. Acta Neurochir (Wien). 2019;161(5):855-64. doi: 10.1007/s00701-019-03868-7.
25. Sugrue M, De Waele JJ, De Keulenaer BL, Roberts DJ, Malbrain ML. A user's guide to intra-abdominal pressure measurement. Anaesthesiol Intensive Ther. 2015;47(3):241-51. doi: 10.5603/AIT.a2015.0025.
26. De Keulenaer BL, De Waele JJ, Powell B, Malbrain ML. What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive Care Med. 2009;35(6):969-76. doi: 10.1007/s00134-009-1445-0.
27. Wilson MH. Monro-Kellie 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure. J Cereb Blood Flow Metab. 2016;36(8):1338-50. doi: 10.1177/0271678X16648711.
28. Steiner LA, Andrews PJ. Monitoring the injured brain: ICP and CBF. Br J Anaesth. 2006;97(1):26-38. doi: 10.1093/bja/ael110.
29. Raboel PH, Bartek J Jr, Andresen M, Bellander BM, Romner B. Intracranial Pressure Monitoring: Invasive versus Non-Invasive Methods-A Review. Crit Care Res Pract. 2012;2012:950393. doi: 10.1155/2012/950393.
30. Batson OV. The function of the vertebral veins and their role in the spread of metastases. Ann Surg. 1940;112(1):138-49. doi: 10.1097/00000658-194007000-00016.
31. Doepp F, Schreiber SJ, Wandinger KP, Trendelenburg G, Valdueza JM. Multiple brain abscesses following surgical treatment of a perianal abscess. Clin Neurol Neurosurg. 2006;108(2):187-90. doi: 10.1016/j.clineuro.2004.11.024.
32. Scalea TM, Bochicchio GV, Habashi N, McCunn M, Shih D, McQuillan K, et al. Increased intra-abdominal, intrathoracic, and intracranial pressure after severe brain injury: multiple compartment syndrome. J Trauma. 2007;62(3):647-56; discussion 656. doi: 10.1097/TA.0b013e31802ee542.
33. Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ. Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J Trauma. 1996;40(6):936-41; discussion 941-3. doi: 10.1097/00005373-199606000-00012.
34. Rosenthal RJ, Hiatt JR, Phillips EH, Hewitt W, Demetriou AA, Grode M. Intracranial pressure. Effects of pneumoperitoneum in a large-animal model. Surg Endosc. 1997;11(4):376-80. doi: 10.1007/s004649900367.
35. Halverson A, Buchanan R, Jacobs L, Shayani V, Hunt T, Riedel C, et al. Evaluation of mechanism of increased intracranial pressure with insufflation. Surg Endosc. 1998;12(3):266-9. doi: 10.1007/s004649900648.
36. Josephs LG, Este-McDonald JR, Birkett DH, Hirsch EF. Diagnostic laparoscopy increases intracranial pressure. J Trauma. 1994;36(6):815-8; discussion 818-9. doi: 10.1097/00005373-199406000-00011.
37. Hammill CW, Au T, Wong LL. Laparoscopic cholecystectomy in a patient with a ventriculoperitoneal shunt. Hawaii Med J. 2010;69(4):103-4.
38. Bondurant CP, Jimenez DF. Epidemiology of cerebrospinal fluid shunting. Pediatr Neurosurg. 1995;23(5):254-8; discussion 259. doi: 10.1159/000120968.
39. Martínez-Lage JF, Martos-Tello JM, Ros-de-San Pedro J, Almagro MJ. Severe constipation: an under-appreciated cause of VP shunt malfunction: a case-based update. Childs Nerv Syst. 2008;24(4):431-5. doi: 10.1007/s00381-007-0514-3.
40. Uzzo RG, Bilsky M, Mininberg DT, Poppas DP. Laparoscopic surgery in children with ventriculoperitoneal shunts: effect of pneumoperitoneum on intracranial pressure--preliminary experience. Urology. 1997;49(5):753-7. doi: 10.1016/S0090-4295(97)00233-1.
41. Cobianchi L, Dominioni T, Filisetti C, Zonta S, Maestri M, Dionigi P, et al. Ventriculoperitoneal shunt and the need to remove a gallbladder: Time to definitely overcome the feeling that laparoscopic surgery is contraindicated. Ann Med Surg (Lond). 2014;3(3):65-7. doi: 10.1016/j.amsu.2014.03.005.
42. Sankpal R, Chandavarkar A, Chandavarkar M. Safety of Laparoscopy in Ventriculoperitoneal Shunt Patients. J Gynecol Endosc Surg. 2011;2(2):91-3. doi: 10.4103/0974-1216.114082.
43. Collure DW, Bumpers HL, Luchette FA, Weaver WL, Hoover EL. Laparoscopic cholecystectomy in patients with ventriculoperitoneal (VP) shunts. Surg Endosc. 1995;9(4):409-10. doi: 10.1007/BF00187161.
44. Neale ML, Falk GL. In vitro assessment of back pressure on ventriculoperitoneal shunt valves. Is laparoscopy safe? Surg Endosc. 1999;13(5):512-5. doi: 10.1007/s004649901024.
45. Al-Mufarrej F, Nolan C, Sookhai S, Broe P. Laparoscopic procedures in adults with ventriculoperitoneal shunts. Surg Laparosc Endosc Percutan Tech. 2005;15(1):28-9. doi: 10.1097/01.sle.0000153733.78227.8f.
46. Matsumoto T, Endo Y, Uchida H, Kusumoto T, Muto Y, Kitano S. An examination of safety on laparoscopic surgery in patients with ventriculoperitoneal shunt by a CO2 reflux experiment. J Laparoendosc Adv Surg Tech A. 2010;20(3):231-4. doi: 10.1089/lap.2010.0038.
47. Martínez Ramos D, Gibert Gerez J, Salvador Sanchís JL. [Laparoscopic surgery in patients with a ventriculoperitoneal shunt]. Rev Esp Enferm Dig. 2006;98(10):795-6. doi: 10.4321/s1130-01082006001000015.
48. Jackman SV, Weingart JD, Kinsman SL, Docimo SG. Laparoscopic surgery in patients with ventriculoperitoneal shunts: safety and monitoring. J Urol. 2000;164(4):1352-4.
49. Fraser JD, Aguayo P, Sharp SW, Holcomb III GW, Ostlie DJ, St Peter SD. The safety of laparoscopy in pediatric patients with ventriculoperitoneal shunts.
J Laparoendosc Adv Surg Tech A. 2009;19(5):675-8. doi: 10.1089/lap.2009.0116.
50. Yoshihara T, Tomimaru Y, Noguchi K, Nagase H, Hamabe A, Hirota M, et al. Feasibility of laparoscopic cholecystectomy in patients with cerebrospinal fluid shunt. Asian J Endosc Surg. 2017;10(4):394-8. doi: 10.1111/ases.12380.
51. Ichikawa Y, Matsuda C, Mizushima T, Takahashi H, Miyoshi N, Haraguchi N, et al. Safety of laparoscopic colorectal surgery in patients with ventriculoperitoneal shunt. Asian J Endosc Surg. 2019;12(3):264-8. doi: 10.1111/ases.12640.
52. Baskin JJ, Vishteh AG, Wesche DE, Rekate HL, Carrion CA. Ventriculoperitoneal shunt failure as a complication of laparoscopic surgery. JSLS. 1998;2(2):177-80.
53. Schwed DA, Edoga JK, McDonnell TE. Ventilatory impairment during laparoscopic cholecystectomy in a patient with a ventriculoperitoneal shunt. J Laparoendosc Surg. 1992;2(1):57-9. doi: 10.1089/lps.1992.2.57.

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