# Laparoscopic low anterior resection in a patient with ventriculoperitoneal shunt: a case report

## TL;DR

A 70-year-old man with a VP shunt safely underwent laparoscopic colon surgery with careful precautions, showing it can be done in adults.

## Contribution

Demonstrates the safety of laparoscopic surgery in an adult with a VP shunt using specific precautions.

## Key findings

- Laparoscopic LAR was performed without neurological or surgical complications.
- Use of low insufflation pressure and intermittent desufflation helped manage risks.
- Patient was discharged on Day 4 with no adverse outcomes.

## Abstract

Hydrocephalus is commonly managed with a ventriculoperitoneal (VP) shunt, and the safety of laparoscopic surgery in these patients remains debated due to concerns regarding shunt malfunction and altered intracranial pressure. Evidence is mostly pediatric, with limited adult data. We report a case of laparoscopic low anterior resection (LAR) in an adult with a VP shunt. A 70-year-old man with a VP shunt placed 10 years prior was diagnosed with a well-differentiated rectosigmoid adenocarcinoma without metastasis. He underwent laparoscopic LAR using low insufflation pressure and intermittent desufflation. The shunt was left unclamped. The procedure was uneventful, and he was discharged on postoperative Day 4 with no neurological or surgical complications. Although historically considered high-risk, current evidence suggests that laparoscopic surgery can be safely performed in patients with VP shunts when careful perioperative measures are taken. Laparoscopic colon resection appears safe in selected VP shunt patients when appropriate precautions are implemented.