A Case of Single-incision Laparoscopic Surgery for an Infected Hepatic Cyst After Ventriculoperitoneal Shunt Insertion

Abstract

The patient was a 57-year-old woman with an inserted ventriculoperitoneal shunt (VPS) after head trauma. She presented with right abdominal pain, and a careful clinical examination led to the suspicion of an infected liver cyst. Percutaneous transhepatic drainage resulted in relief from the pain, but the cyst subsequently relapsed. A single-incision laparoscopic hepatic cyst deroofing was performed. To prevent cerebrospinal fluid infection, the VPS was clamped extracorporeally. Careful attention was paid to prevent intraperitoneal spillage of the cyst fluid, and intraoperative indocyanine green (ICG) examination confirmed the absence of biliary leakage. No intraperitoneal drain was placed. There is no consensus on the surgical approach for and perioperative management of patients with a VPS tube. Minimally invasive surgery by single-incision laparoscopic surgery (SILS) was considered feasible if potential infection-conscious treatment was performed in combination with VPS clamping and intraoperative ICG examination.