LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH VENTRICULOPERITONEAL (VP) SHUNTS

Increased intracranial pressure is often relieved by a ventriculoperit oneal shunt. The shunt has a one-way valve which can withstand pressur es of 300 mmHg and prevent reflux of intraabdominal fluid. We have uti lized laparoscopy for cholecystectomy in four patients with VP shunts. In all patients the peritoneal cavity was free of adhesions. When CO2 insufflation pressure was as high as 10-15 mmHg cerebrospinal fluid w as still noted to flow from the end of the shunts. In three patients t he entire procedure was performed laparoscopically. In the fourth pati ent the procedure was converted to an open cholecystectomy because of extensive inflammation surrounding a gangrenous gallbladder, Postopera tively the shunts remained intact and functional. There were no centra l nervous system sequelae. None of the shunts became infected. Electiv e laparoscopic cholecystectomy in patients with VP shunts can be done safely without a need for clamping or other manipulation of the shunt.