Cholecystectomy in patients with prior ventriculoperitoneal shunts.

BACKGROUND: There is little published evidence regarding intraoperative and postoperative complications in patients with ventriculoperitoneal shunts who undergo cholecystectomy. METHODS: Nationwide Department of Veterans Affairs databases were searched to identify patients with International Classification of Diseases, 9th revision, Clinical Modification codes for a VP shunt who later had a cholecystectomy during fiscal years 1994 to 2003. Charts on these patients were obtained and reviewed. RESULTS: Twenty-three patients were deemed evaluable. Of these, 8 had laparoscopic converted to open cholecystectomies. All conversions were owing to dense adhesions. There were 2 cases of postoperative shunt infection that required shunt removal and replacement. CONCLUSIONS: The rate of conversion from laparoscopic to open cholecystectomy was 57% in this study, significantly higher than the reported rate of conversion for patients without shunts in Department of Veterans Affairs Medical Centers (5%). Cholecystectomy in adult patients with a preexisting ventriculoperitoneal shunt appears to result in a shunt infection rate similar to that reported after shunt insertion or revision.

Appendectomy for appendicitis in patients with a prior ventriculoperitoneal shunt.

BACKGROUND: Approximately 18,000 cerebrospinal fluid shunts, the majority of which are ventriculoperitoneal, are placed each year in the United States. These patients may develop appendicitis and require surgery. Whether the risk of postoperative complications is increased in these patients is unknown. We sought to determine the clinical course of patients with ventriculoperitoneal (VP) shunts who undergo appendectomy for appendicitis. METHODS: A nationwide search of Department of Veterans Affairs databases was conducted to identify patients with a VP shunt who subsequently developed appendicitis and underwent appendectomy. Patient medical records were analyzed to determine if the presence of a VP shunt affected the surgical approach or the postoperative course of patients who underwent appendectomy. RESULTS: Ten patients had ICD-9-CM codes for both appendectomy and a VP shunt. Five met the inclusion criteria for the study and had sufficient data for analysis. Medical records indicated that all of the patients had perforated or gangrenous appendicitis with peritonitis. One patient's VP shunt was converted to a ventriculoatrial shunt. Another patient's shunt was removed when culture of his peritoneal fluid grew Gram-positive cocci. There were no instances of postoperative infection, shunt malfunction, or other complication. CONCLUSION: This is the only English language study, to our knowledge, of the clinical course of adults with VP shunts in place at the time of appendectomy for appendicitis. Such patients generally have no complications related to shunt malfunction or infection. In a minority of patients, shunt revision may be required.