Background

Morbid obesity is associated with various comorbid conditions, including idiopathic intracranial hypertension (IIH). IIH and other intracranial conditions can be treated with ventriculoperitoneal (VP) shunting. Patients with obesity and VP shunts may present for metabolic/bariatric surgery. Intraoperatively, VP shunts can be left in place or temporarily 'externalized,' by bringing the shunt out of the abdomen to prevent shunt infection. Previously, shunt externalization was recommended during laparoscopic metabolic/bariatric surgery. ObjectiveWe examined outcomes of patients at our institution undergoing laparoscopic metabolic/bariatric surgery without VP shunt externalization. SettingAcademic university hospital

Methods

Using procedure and diagnosis codes in an electronic medical record search, patients who underwent a laparoscopic metabolic/bariatric operation with a VP shunt in place between 2000 and 2023 were reviewed.

Results

We identified 10 patients who met inclusion criteria. Five patients underwent laparoscopic sleeve gastrectomy (LSG), and 5 patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). Excess weight loss (EWL%) averaged 35.09% at six months, and 46.00% at 12 months. There were no intraoperative complications. There was one case of a postoperative infected hematoma which required shunt externalization during source control. One patient underwent shunt ligation 17 months after LRYGB (by which time she achieved 99.34% EWL) for headaches likely related to intracranial hypotension. One patient has not completed follow-up yet.

Conclusions

Our results suggest it is safe to leave VP shunts in place during laparoscopic metabolic/bariatric surgery, and that the procedures result in effective weight loss in this patient population.