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Laparoscopic bariatric surgery in a patient with idiopathic intracranial hypertension and lumboperitoneal shunt: Anesthetic implications

Idiopathic intracranial hypertension (IIH) typically affects obese young women. Treatment is mainly medical, but some cases require surgery; ventriculoperitoneal (VPS) or lumboperitoneal shunts (LPS) being the most common procedures. Although bariatric surgery is not the first-line surgical treatmen...

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Autores principales: López, Teresa, Trébol, Jacobo, Sastre, José A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796751/
https://www.ncbi.nlm.nih.gov/pubmed/33447195
http://dx.doi.org/10.4103/sja.SJA_190_20
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author López, Teresa
Trébol, Jacobo
Sastre, José A.
author_facet López, Teresa
Trébol, Jacobo
Sastre, José A.
author_sort López, Teresa
collection PubMed
description Idiopathic intracranial hypertension (IIH) typically affects obese young women. Treatment is mainly medical, but some cases require surgery; ventriculoperitoneal (VPS) or lumboperitoneal shunts (LPS) being the most common procedures. Although bariatric surgery is not the first-line surgical treatment, it can be useful in refractory cases and allows treating the major underlying risk factor and its comorbidities. Laparoscopic bariatric surgery is the gold standard; however, literature in patients with shunts is scarce. In the present study, we report the case of a morbidly obese female with IIH treated with an LPS and with refractory headache, scheduled for laparoscopic Roux-en-Y gastric bypass. LPS position was checked before surgery (abdominal X-ray) and during pneumoperitoneum was clamped. Anesthetic management was guided to minimize increases in intracranial pressure (ICP). Surgery and anesthesia were uneventful. Three months later, headaches disappeared and analgesics were discontinued. In conclusion, laparoscopic bariatric surgery may be an option for IIH. It is safe in patients with LPS, although concerns should be taken into account (avoid any damage to the shunt, limit digestive tract contents spillage, and strict vigilance for early detection of intracranial hypertension signs). Although valve system could prevent pressure complications, the catheter can be clamped to avoid retrograde insufflation of CO(2) or digestive tract content.
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spelling pubmed-77967512021-01-13 Laparoscopic bariatric surgery in a patient with idiopathic intracranial hypertension and lumboperitoneal shunt: Anesthetic implications López, Teresa Trébol, Jacobo Sastre, José A. Saudi J Anaesth Case Report Idiopathic intracranial hypertension (IIH) typically affects obese young women. Treatment is mainly medical, but some cases require surgery; ventriculoperitoneal (VPS) or lumboperitoneal shunts (LPS) being the most common procedures. Although bariatric surgery is not the first-line surgical treatment, it can be useful in refractory cases and allows treating the major underlying risk factor and its comorbidities. Laparoscopic bariatric surgery is the gold standard; however, literature in patients with shunts is scarce. In the present study, we report the case of a morbidly obese female with IIH treated with an LPS and with refractory headache, scheduled for laparoscopic Roux-en-Y gastric bypass. LPS position was checked before surgery (abdominal X-ray) and during pneumoperitoneum was clamped. Anesthetic management was guided to minimize increases in intracranial pressure (ICP). Surgery and anesthesia were uneventful. Three months later, headaches disappeared and analgesics were discontinued. In conclusion, laparoscopic bariatric surgery may be an option for IIH. It is safe in patients with LPS, although concerns should be taken into account (avoid any damage to the shunt, limit digestive tract contents spillage, and strict vigilance for early detection of intracranial hypertension signs). Although valve system could prevent pressure complications, the catheter can be clamped to avoid retrograde insufflation of CO(2) or digestive tract content. Wolters Kluwer - Medknow 2020 2020-09-24 /pmc/articles/PMC7796751/ /pubmed/33447195 http://dx.doi.org/10.4103/sja.SJA_190_20 Text en Copyright: © 2020 Saudi Journal of Anesthesia http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Case Report
López, Teresa
Trébol, Jacobo
Sastre, José A.
Laparoscopic bariatric surgery in a patient with idiopathic intracranial hypertension and lumboperitoneal shunt: Anesthetic implications
title Laparoscopic bariatric surgery in a patient with idiopathic intracranial hypertension and lumboperitoneal shunt: Anesthetic implications
title_full Laparoscopic bariatric surgery in a patient with idiopathic intracranial hypertension and lumboperitoneal shunt: Anesthetic implications
title_fullStr Laparoscopic bariatric surgery in a patient with idiopathic intracranial hypertension and lumboperitoneal shunt: Anesthetic implications
title_full_unstemmed Laparoscopic bariatric surgery in a patient with idiopathic intracranial hypertension and lumboperitoneal shunt: Anesthetic implications
title_short Laparoscopic bariatric surgery in a patient with idiopathic intracranial hypertension and lumboperitoneal shunt: Anesthetic implications
title_sort laparoscopic bariatric surgery in a patient with idiopathic intracranial hypertension and lumboperitoneal shunt: anesthetic implications
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796751/
https://www.ncbi.nlm.nih.gov/pubmed/33447195
http://dx.doi.org/10.4103/sja.SJA_190_20
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AT sastrejosea laparoscopicbariatricsurgeryinapatientwithidiopathicintracranialhypertensionandlumboperitonealshuntanestheticimplications