title: Feasibility of laparoscopic cholecystectomy in patients with cerebrospinal fluid shunt.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Analysis of our current cases suggests the safety of laparoscopic cholecystectomy in cases with CSF shunts.
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Terukazu
authors.initials: T
authors.lastname: Yoshihara
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Tomimaru
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Kozo
authors.initials: K
authors.lastname: Noguchi
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Nagase
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hamabe
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirota
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Kazuteru
authors.initials: K
authors.lastname: Oshima
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Tanida
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Morita
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwazawa
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Akagi
authors.affiliation: Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.
authors.forename: Keizo
authors.initials: K
authors.lastname: Dono
mesh_terms: D000368:Aged; D002557:Cerebrospinal Fluid Shunts; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Laparoscopic cholecystectomy; lumboperitoneal shunt; ventriculoperitoneal shunt