title: In vitro assessment of back pressure on ventriculoperitoneal shunt valves. Is laparoscopy safe?
abstract: BACKGROUND
  Whereas there are case reports of laparoscopy in patients with ventriculoperitoneal shunts, there are no studies assessing the potential failure of shunt valves with the increased intra-abdominal pressure of laparoscopy. This study aims to assess this factor.
  
  
  METHODS
  An in vitro model was used to assess the potential for retrograde failure of ventriculoperitoneal shunt valves in a commonly used shunt. Nine shunts were subjected to graded increases in back pressure and observed for retrograde valve leak.
  
  
  RESULTS
  None of the shunts tested showed any signs of leak associated with the increased back pressure. However, disruption of shunt seals was noted in seven of the nine shunts, occurring at the minimal pressure of 80 mmHg.
  
  
  CONCLUSIONS
  There appears to be minimal risk of retrograde failure of the valve system in the ventriculoperitoneal shunt tested. However, tests on different types of ventriculoperitoneal shunts would be needed to confirm these results if laparoscopy is to be considered safe in patients with ventriculoperitoneal shunts in situ.
authors.affiliation: Repatriation General Hospital Concord, Sydney, NSW, Australia.
authors.forename: M L
authors.initials: ML
authors.lastname: Neale
authors.forename: G L
authors.initials: GL
authors.lastname: Falk
mesh_terms: D004868:Equipment Failure; D066298:In Vitro Techniques; D010535:Laparoscopy / Q000009:adverse effects*; D011312:Pressure; D017287:Ventriculoperitoneal Shunt