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Narayan R, Fried T, Chica G, Schaefer M, Mullins D. Minimally invasive fluoroscopic percutaneous peritoneal dialysis catheter salvage. Clin Kidney J 2015; 7:264-8. [PMID: 25852887 PMCID: PMC4377760 DOI: 10.1093/ckj/sfu042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/18/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Peritoneal dialysis catheter (PDC) dysfunction can often be treated fluoroscopically by manipulation with wire, balloon or stiff stylet, saving surgical intervention for refractory cases. We describe an enhanced percutaneous approach to PDC salvage that can lead to a more definitive intervention and salvage for cases refractory to fluoroscopic manipulation. METHODS In five cases of PD catheter malfunction, the deep cuff was dissected free after a 0.035 hydrophilic wire was passed into the peritoneum through the PDC. Only the intraperitoneal portion of the PDC was explanted. The PDC was cleared of obstruction and omentum. The intraperitoneal portion of the PDC was reimplanted over wire via a peel-away sheath and the deep cuff sutured. RESULTS Omental entrapment was present in three of five patients and fibrin occlusion in four of the five cases. All catheters were repaired successfully by the described technique. Post procedure, 3-5 days of lower volume, recumbent PD exchanges were performed prior to full-dose PD. No perioperative complications or leaks were noted. All PDCs were patent at 6 months. One patient required laparoscopy for recurrent omental wrapping 3 months post intervention. CONCLUSIONS PDC salvage in this manner is a cost-effective alternative to laparoscopic repair of PDCs failing catheter manipulation. The infection barrier afforded by the original superficial cuff and subcutaneous tunnel is maintained. PD can be resumed immediately. Only refractory cases need laparoscopy. This procedure allows for a more definitive correction of catheter migration and obstruction, avoids placement of a new PDC or temporary hemodialysis, is cost-effective and expands percutaneous options for dysfunctional PD catheters.
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Affiliation(s)
- Rajeev Narayan
- Clinical and Interventional Nephrology , San Antonio Kidney Disease Center , San Antonio, TX , USA
| | - Terrance Fried
- Clinical Nephrology, San Antonio Kidney Disease Center , University of Texas Health Science Center at San Antonio , San Antonio, TX , USA
| | - Gerardo Chica
- Clinical and Interventional Nephrology , San Antonio Kidney Disease Center , San Antonio, TX , USA
| | - Mathew Schaefer
- Clinical and Interventional Nephrology , San Antonio Kidney Disease Center , San Antonio, TX , USA
| | - Daniel Mullins
- Clinical and Interventional Nephrology , San Antonio Kidney Disease Center , San Antonio, TX , USA
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Abstract
There is no shortage of studies and registry data examining outcomes of patients on dialysis and those with a renal transplant. However, recently, there has been a greater focus on the events leading up to the institution of kidney replacement therapy. Associative data suggest that early and consistent predialysis care leads to better outcomes, including greater take-on to home-based therapy, diminished use of tunneled venous hemodialysis catheters, and improved early and even late survival. What transpires during predialysis visits is also important. Simple dissemination of facts to the unprepared patient is unlikely to be effective in moving the patient and family along in the process of the series of choices that have to be made around therapy. A more flexible and circumspect approach is needed, including recognizing when the patient is or is not ready for change. There seems to be no optimal timing of dialysis start that can be applied to the ESRD population as a whole, although the pendulum seems to be swinging back toward symptom-based rather than eGFR-based starts.
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Affiliation(s)
- Joanne M Bargman
- Medicine/Nephrology, University Health Network, Toronto, Ontario, Canada; and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Liu YY, Diana M, Halvax P, Cho S, Légner A, Alzaga A, Swanström L, Dallemagne B, Marescaux J. Flexible endoscopic single-incision extraperitoneal implant and fixation of peritoneal dialysis catheter: proof of concept in the porcine model. Surg Endosc 2014; 29:2402-6. [PMID: 25414067 DOI: 10.1007/s00464-014-3951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/11/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) catheters placed in the pelvic space without anchoring present a high rate of migration. We aimed to assess the feasibility of a single-incision approach, using a flexible endoscopic preperitoneal tunneling for catheter implantation and fixation. MATERIALS AND METHODS Eight pigs were involved in this experimental study. A 2/0 Vicryl loop was sutured at the tip of a PD catheter. In 4 pigs, a 1.5 cm incision was made on the left paramedian line and the parietal peritoneal layer was identified by splitting rectal muscles. A gastroscope was inserted in the incision and advanced in the extraperitoneal space. An exit hole was made in the peritoneum over the low pelvic cavity. A guidewire was left in the abdominal cavity, and the PD catheter was inserted over the guidewire. The endoscope was inserted in the tunnel again, and endoscopic clips were deployed over the Vicryl loop to fix the catheter. In 4 pigs, the PD catheter was inserted laparoscopically using a two-port approach. The catheter's tip was fixed with laparoscopic clips on the Vicryl loop. A strain test to assess the force required to detach clips was performed using a digital dynamometer. RESULTS Operative time for flexible endoscopic tunneling was longer when compared to the laparoscopic implant (29.5 ± 4.43 vs. 22.7 ± 2.51 min). Mean force to displace the catheter was similar after flexible endoscopic fixation when compared to laparoscopic clip fixation (5.57 N ± 2.76 vs. 4.15 N ± 1.76). CONCLUSIONS Flexible endoscopic extraperitoneal tunneling allows for minimally invasive single-incision PD catheter placement and fixation.
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Affiliation(s)
- Yu-Yin Liu
- IRCAD, Digestive and Endocrine Surgery, University of Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
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Perl J, Pierratos A, Kandasamy G, McCormick BB, Quinn RR, Jain AK, Huang A, Paterson JM, Oliver MJ. Peritoneal dialysis catheter implantation by nephrologists is associated with higher rates of peritoneal dialysis utilization: a population-based study. Nephrol Dial Transplant 2014; 30:301-9. [PMID: 25414373 DOI: 10.1093/ndt/gfu359] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The likelihood of peritoneal dialysis (PD) utilization following a PD catheter insertion attempt is poorly described. We explored the risk factors for PD nonuse, focusing on the method of PD catheter implantation. METHODS This population-based retrospective cohort study employed Ontario administrative health data to identify 3886 predialysis adults who had an incident PD catheter implantation between 2002 and 2010. The impact of the method of catheter implantation including open-surgical (open, n = 1884), surgical-laparoscopic (laparoscopic, n = 1154), nephrology-percutaneous (nephrology, n = 498) and radiology-percutaneous (radiology, n = 350) on rates of PD utilization (defined as four consecutive weeks of PD) was examined. RESULTS Eighty-three percent of study patients received PD. After adjustment, relative to patients with openly inserted catheters, PD utilization was greater for those with nephrology-inserted catheters [adjusted hazard ratio (aHR) 1.59, 95% confidence interval (CI) 1.29-1.95] and similar for radiology-inserted catheters [aHR 1.16, 95% CI 0.94-1.43] or laparoscopic-inserted catheters [aHR 0.97 (95% CI 0.86-1.09)]. Among PD nonusers, death occurred in 10% of the open group, 6% of the laparoscopic group, 27% of the radiology group and in fewer than 3% of the nephrology group. Sixty-nine percent received hemodialysis in the open group, 63% in the laparoscopic group, 61% in the radiology group and 88% in the nephrology group. Those remaining predialysis comprised 12% of the open group, 22% of the laparoscopic group, 11% of the radiology group and <3% of the nephrology group. CONCLUSIONS Nephrology insertion resulted in lower overall rates of PD nonuse, particularly due to death or remaining predialysis. Greater use may be related to insertion timing, technique or greater commitment on the part of nephrologists to the success of PD.
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Affiliation(s)
- Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada Division of Nephrology, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andreas Pierratos
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada Ontario Renal Network, Toronto, Ontario, Canada
| | | | | | - Robert R Quinn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Arsh K Jain
- Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Anjie Huang
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - J Michael Paterson
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Matthew J Oliver
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
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Guidelines for laparoscopic peritoneal dialysis access surgery. Surg Endosc 2014; 28:3016-45. [DOI: 10.1007/s00464-014-3851-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
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Jiang C, Xu L, Chen Y, Yan X, Sun C, Zhang M. A modified open surgery technique for peritoneal dialysis catheter placement decreases catheter malfunction. Perit Dial Int 2014; 34:358-67. [PMID: 24991051 DOI: 10.3747/pdi.2011.00298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This retrospective study was conducted to evaluate the effect of a new, modified open surgery technique on catheter-related malfunction. METHODS During the period from January 1997 to June 2009, 216 patients received initial peritoneal catheters. For the present study, patients were divided into four groups according to the catheter types and the surgery techniques: TO-S: traditional open surgery, straight Tenckhoff catheter TO-C: traditional open surgery, coiled Tenckhoff catheter TO-SN: traditional open surgery, swan-neck catheter MO-S: modified open surgery, straight Tenckhoff catheter The modified surgery was characterized by a low incision site, a short intra-abdominal catheter segment and an additional upward straight subcutaneous tunnel. All patients were followed up for 2 years or until death. Survival rates, complications caused by catheter placement, and the probability of malfunction-free catheter survival were compared between the groups. RESULTS Catheter malfunction was the most frequent mechanical complication, found in 31 patients (14.4%), who experienced 38 malfunctions. Only 2 episodes of catheter malfunction were found in the MO-S group, representing a rate significantly less than those in the TO-S and TO-C groups (both p < 0.05). Kaplan-Meier curves for malfunction-free PD catheter survival showed a significantly different malfunction-free probability for the various groups (p = 0.009). After 2 years of follow-up, 136 patients (63.0%) survived with their initial PD catheter. The initial catheter survival rate was 76.8% in the MO-S group. Kaplan-Meier curves for initial catheter survival showed that the highest survival rate was found in the MO-S group (p = 0.001). CONCLUSIONS The modified open surgery technique is a reliable method for catheter placement.
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Affiliation(s)
- Chunming Jiang
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
| | - Linfeng Xu
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
| | - Yun Chen
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
| | - Xiang Yan
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
| | - Cheng Sun
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
| | - Miao Zhang
- Department of Nephrology, and Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, Nanjing, PR China
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Burnett DR, Huyett LM, Zisser HC, Doyle FJ, Mensh BD. Glucose sensing in the peritoneal space offers faster kinetics than sensing in the subcutaneous space. Diabetes 2014; 63:2498-505. [PMID: 24622798 PMCID: PMC4066336 DOI: 10.2337/db13-1649] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The paramount goal in the treatment of type 1 diabetes is the maintenance of normoglycemia. Continuous glucose monitoring (CGM) technologies enable frequent sensing of glucose to inform exogenous insulin delivery timing and dosages. The most commonly available CGMs are limited by the physiology of the subcutaneous space in which they reside. The very same advantages of this minimally invasive approach are disadvantages with respect to speed. Because subcutaneous blood flow is sensitive to local fluctuations (e.g., temperature, mechanical pressure), subcutaneous sensing can be slow and variable. We propose the use of a more central, physiologically stable body space for CGM: the intraperitoneal space. We compared the temporal response characteristics of simultaneously placed subcutaneous and intraperitoneal sensors during intravenous glucose tolerance tests in eight swine. Using compartmental modeling based on simultaneous intravenous sensing, blood draws, and intraarterial sensing, we found that intraperitoneal kinetics were more than twice as fast as subcutaneous kinetics (mean time constant of 5.6 min for intraperitoneal vs. 12.4 min for subcutaneous). Combined with the known faster kinetics of intraperitoneal insulin delivery over subcutaneous delivery, our findings suggest that artificial pancreas technologies may be optimized by sensing glucose and delivering insulin in the intraperitoneal space.
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Affiliation(s)
| | - Lauren M Huyett
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA
| | - Howard C Zisser
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CASansum Diabetes Research Institute, Santa Barbara, CA
| | - Francis J Doyle
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, CA
| | - Brett D Mensh
- Theranova, LLC, San Francisco, CAJanelia Farm Research Campus, Howard Hughes Medical Institute, Ashburn, VA
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Chen G, Wang P, Liu H, Zhou L, Cheng M, Liu Y, Zhang H, Li J, Sun L, Peng Y, Liu F. Greater omentum folding in the open surgical placement of peritoneal dialysis catheters: a randomized controlled study and systemic review. Nephrol Dial Transplant 2014; 29:687-97. [PMID: 24084323 DOI: 10.1093/ndt/gft357] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Mechanical catheter dysfunction caused by omentum entrapment remains a major complication of peritoneal dialysis (PD) therapy. The purpose of this study was to determine the outcomes of omentum folding at the time of primary open catheter insertion. METHODS From March 2008 to December 2012, a total of 67 PD subjects were enrolled in the study and randomly assigned to receive either regular open insertion (ROI group, n = 33) or open insertion with omentum folding (OIOF group, n = 34). The primary outcome was defined as PD catheter tip migration with dysfunction. A systematic review was performed to analyze the outcomes of omentum management in PD catheter implantation, based on published data from 1990 to 2013. RESULTS There was no statistical difference in baseline patient characteristics between the ROI and OIOF groups. Nine (27.3%) patients in the ROI group presented with catheter malposition in the late stage (>60 days) of the study, significantly more than in the OIOF group (two; 5.9%) (P = 0.049). Significant differences in catheter survival rate between the two groups were observed in the late stage (P = 0.030) and over the entire study period (P = 0.028). A higher incidence of irreversible catheter dysfunction was shown in the ROI group (15.2%), whereas none occurred in the OIOF group (P = 0.031). No statistical difference was determined in other catheter-related complications or patient survival rate. There were no statistical differences in peritoneal transport characteristics or dialysis adequacy between the two groups upon evaluation at 3, 6 and 12 months. Systemic review of current publications suggested that PD catheter placement with omentum management could lead to less irreversible catheter dysfunction and improved outcome of catheter survival. CONCLUSIONS Our data suggest that omentum folding at the initial time of open catheter placement can significantly reduce the risk of catheter tip migration with dysfunction and improve the outcome of the PD technique.
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Affiliation(s)
- Guochun Chen
- Renal Division, The Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
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Abdel-Aal AK, Dybbro P, Hathaway P, Guest S, Neuwirth M, Krishnamurthy V. Best practices consensus protocol for peritoneal dialysis catheter placement by interventional radiologists. Perit Dial Int 2014; 34:481-93. [PMID: 24584622 DOI: 10.3747/pdi.2013.00029] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Peritoneal dialysis (PD) catheters can be placed by interventional radiologists, an approach that might offer scheduling efficiencies, cost-effectiveness, and a minimally invasive procedure. In the United States, changes in the dialysis reimbursement structure by the Centers for Medicare and Medicaid Services are expected to result in the increased use of PD, a less costly dialysis modality that offers patients the opportunity to receive dialysis in the home setting and to have more independence for travel and work schedules, and that preserves vascular access for future dialysis options. Placement of PD catheters by interventional radiologists might therefore be increasingly requested by nephrology practices, given that recent publications have demonstrated the favorable impact on PD practices of an interventional radiology PD placement capability. Earlier reports of interventional radiology PD catheter placement came from single-center practices with smaller reported experiences. The need for a larger consensus document that attempts to establish best demonstrated practices for radiologists is evident. The radiologists submitting this consensus document represent a combined experience of more than 1000 PD catheter placements. The authors submit these consensus-proposed best demonstrated practices for placement of PD catheters by interventional radiologists under ultrasonographic and fluoroscopic guidance. This technique might allow for expeditious placement of permanent PD catheters in late-referred patients with end-stage renal disease, thus facilitating urgent-start PD and avoiding the need for temporary vascular access catheters.
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Affiliation(s)
- Ahmed K Abdel-Aal
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Paul Dybbro
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Peter Hathaway
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Steven Guest
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Michael Neuwirth
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Venkat Krishnamurthy
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; Interventional Radiology, Kaiser Permanente Hayward, Hayward, California; Interventional Radiology, Utah Vascular Clinic, Salt Lake City, Utah; Baxter Healthcare Corporation, Deerfield, Illinois; Vascular and Interventional Radiology, Carle Foundation Hospital and Carle Physician Group, Urbana, Illinois; and Radiology Services, VA Ann Arbor Health System, Ann Arbor, Michigan, USA
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Bagul A, Thiyagarajan UM, Mamode N. Laparoscopic peritoneal dialysis catheter (PDC) insertion: does it really make a difference? J Nephrol 2014; 27:127-34. [PMID: 24536002 DOI: 10.1007/s40620-013-0031-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 07/28/2013] [Indexed: 11/26/2022]
Abstract
Permanent peritoneal dialysis (PD) access was first described and introduced in clinical practice more than 40 years ago. It is still undergoing modification and adaptation to various insertion techniques. PD Catheter insertion is commonly performed via one of the three techniques: (a) open surgical, (b) fluoroscopic-guided placement or blind percutaneous placements using a modified Seldinger technique and (c) minimally invasive. Catheter placement is thought to be the key to a successful PD programme and the economic advantages are lost if a patient switches to HD during the 1st year due to failure of PD. The objective of this document was to conduct an evidence-based assessment of a minimally invasive approach to PD catheter insertion, with particular regard to failure rates secondary to catheter dysfunction. Case series and randomised controlled trials suggest that laparoscopic placement of peritoneal dialysis catheters is safe, and useful for insertion of PD catheters in patients who have undergone previous abdominal surgery. An overall success rate of 90% with a less than 5% associated leak rate has been quoted, although a cost benefit analysis has not been performed. However, good grade I evidence is lacking and open surgery may be quicker, though results from on-going trial are awaited with interest.
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Modaghegh MHS, Kazemzadeh G, Rajabnejad Y, Nazemian F. Preperitoneal tunneling-a novel technique in peritoneal dialysis catheter insertion. Perit Dial Int 2014; 34:443-6. [PMID: 24385332 DOI: 10.3747/pdi.2011.00311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION This study describes a new preperitoneal tunneling (PPT) method for inserting a peritoneal dialysis catheter (PDC), thereby lessening surgical complications and increasing the catheter's survival. METHODS This new technique was used in 23 cases from December 2005 to January 2007 and followed up until March 2011 (63 months). The procedure was performed laparoscopically under local (16 cases) or general (7 cases) anesthesia by one surgeon. Catheter survival is reported by Kaplan-Meyer analysis. RESULTS The catheters were mechanically obstructed in 2/23 cases (8.7%); and were withdrawn due to a peritonitis in 2 cases and inadequacy of peritoneal dialysis in 1 case. Ten patients received kidney transplantation and six died before completing this follow-up period. The patients still reaped the benefits of the PDC until receiving a kidney transplant or death. The 5-year survival rate of the catheter was 89%. No incidence of catheter migration, omental wrapping, herniation or leakage was noticed. CONCLUSION Preperitoneal tunneling is a simple and safe method for insertion of PDC, and can effectively prevent catheter migration, dislocation and omental wrapping.
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Affiliation(s)
- Mohammad-Hadi Saeed Modaghegh
- Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gholamhossein Kazemzadeh
- Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yaser Rajabnejad
- Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Nazemian
- Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Matsui K, Tsuzuku Y, Funaki T, Kubota M. Peritoneal dialysis catheter obstruction caused by fimbriae of the fallopian tube : six case reports. ACTA ACUST UNITED AC 2014. [DOI: 10.4009/jsdt.47.569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Davis WT, Dageforde LA, Moore DE. Laparoscopic versus open peritoneal dialysis catheter insertion cost analysis. J Surg Res 2013; 187:182-8. [PMID: 24555879 DOI: 10.1016/j.jss.2013.09.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/23/2013] [Accepted: 09/27/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND Peritoneal dialysis (PD) is a cost-effective alternative to hemodialysis (HD). PD catheters have traditionally been inserted through a small open incision, but insertion using laparoscopic visualization has become increasingly popular and is associated with less catheter malfunction. The aim of this study was to compare costs of laparoscopic and open insertion strategies while taking into account postoperative complications and future salvage procedures. METHODS A decision analysis model was constructed to simulate 1 y outcomes after PD catheter insertion by either the open or laparoscopic approach. Possible outcomes after PD catheter placement included functional catheter, infection, and catheter malfunction. Ultimately, patients continued with successful PD or switched to HD. Baseline probabilities, costs, and ranges were determined from a critical review of the literature. Sensitivity analyses were performed to determine the model strength over a range of clinically relevant probabilities. RESULTS The total annual costs, including postoperative management and dialysis treatment, were $69,491 for laparoscopic insertion and $69,960 for open insertion. In case of a catheter malfunction, an initial attempt at salvage by fluoroscopy-guided wire manipulation cost less than a first attempt by laparoscopic repositioning. CONCLUSIONS When accounting for a year of postoperative management and treatment, laparoscopic insertion can be less costly than open insertion in the hands of an experienced surgeon. Despite higher initial costs, PD catheter insertion under laparoscopic visualization can have lower total costs due to fewer postoperative complications. With increasing emphasis on cost-effective care, laparoscopic insertion is a valuable tool for initiating PD.
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Affiliation(s)
- William T Davis
- Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
| | - Leigh Anne Dageforde
- Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - Derek E Moore
- Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN
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Kao CY, Chuang JH, Lee SY. A new simplified one-port laparoscopic technique for peritoneal dialysis catheter placement. Perit Dial Int 2013; 34:109-13. [PMID: 24084839 DOI: 10.3747/pdi.2012.00130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED BACKGROUND Various techniques for laparoscopic insertion of a peritoneal dialysis catheter have been described. Usually 2 - 3 ports are required, and complications related to the port sites (such as abdominal wall hernia, leakage, and hemorrhage) cannot be avoided. To minimize the potential complications, we designed a simplified 1-port laparoscopic technique for peritoneal dialysis catheter placement. ♢ METHODS We conducted a retrospective data review of 44 patients who underwent 1-port laparoscopic insertion of a Tenckhoff catheter from June 2009 to February 2011. All patient data, including postoperative complications, were analyzed. ♢ RESULTS The mean follow-up period was 11.52 months. All catheters were working properly, except in 1 patient who developed peritonitis 3 months after catheter placement. (The catheter was removed.) No postoperative abdominal wall hemorrhage, early leaks, hernias, or catheter migration occurred. No exit-site or tunnel infections were observed. ♢ CONCLUSIONS Our 1-port laparoscopic technique provides excellent catheter fixation, avoids excessive port sites, and yields good cosmesis. The low complication rate and the simplicity of the method justify its standard use for Tenckhoff catheter placement.
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Affiliation(s)
- Chun-Yu Kao
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Yeh CN, Liao CH, Liu YY, Cheng CT, Wang SY, Chiang KC, Tian YC, Chiu CC, Weng SM, Hwang TL. Dual-incision laparoscopic surgery for peritoneal dialysis catheter implantation and fixation: a novel, simple, and safe procedure. J Laparoendosc Adv Surg Tech A 2013; 23:673-8. [PMID: 23837512 DOI: 10.1089/lap.2013.0156] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is an alternative modality to hemodialysis and is usually used to treat patients with end-stage renal disease. Dual-incision laparoscopic surgery (DILS) had been reported in several surgical fields; however, no report was proposed about DILS in PD catheter implantation (DILS-PD). In this study, we present DILS with a novel, simple, and safe procedure for PD catheter implantation with fixation and describe the long-term outcome. SUBJECTS AND METHODS We conducted a prospective data collection and retrospective review of all PD patients from April 2010 until June 2012. During this study period, we performed open surgery for PD catheter implantation (OS-PD) and DILS-PD concurrently. Demographic data, medical, operative, and postoperative findings, and information regarding complications were compared between these two groups. RESULTS Forty-eight patients had DILS-PD, and 70 patients had OS-PD. There was no difference between the two groups in age, gender, American Society of Anesthesiologists grade, creatinine level, body mass index, and previous abdominal surgery. There was no surgical mortality in either group. The follow-up period ranged from 6 to 24 months, with a mean of 22.4±16.5 months. There was no tube migration in the DILS-PD group, but 25.7% of the patients in the OS-PD group had tube migration (P<.001). A significantly decreased exit-site/tunnel infection rate was found in the DILS-PD group (4.2%) compared with the OS-PD group (17.1%) (P=.032). However, there was no obvious difference in peritonitis occurrence between groups. A significantly decreased catheter failure rate was found in the DILS-PD group (4.2%) compared with the OS-PD group (22.9%) (P=.006). DILS-PD group patients had a favorable survival rate for catheter implantation compared with OS-PD group patients. CONCLUSIONS Our DILS-PD with fixation technique is a simple and safe procedure. This procedure minimized or even eliminated the possibility of migration without additional cost. Our DILS-PD fixatation technique should be recommended for use routinely.
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Affiliation(s)
- Chun-Nan Yeh
- Department of Surgery, Chang Gung University, Taoyuan, Taiwan
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66
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Wong LP, Yamamoto KT, Reddy V, Cobb D, Chamberlin A, Pham H, Sun SJ, Mallareddy M, Saldivar M. Patient education and care for peritoneal dialysis catheter placement: a quality improvement study. Perit Dial Int 2013; 34:12-23. [PMID: 23818002 DOI: 10.3747/pdi.2012.00190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED BACKGROUND AND OBJECTIVES Peritoneal dialysis catheter (PDC) complications are an important barrier to peritoneal dialysis (PD) utilization. Practice guidelines for PDC placement exist, but it is unknown if these recommendations are followed. We performed a quality improvement study to investigate this issue. ♢ METHODS A prospective observational study involving 46 new patients at a regional US PD center was performed in collaboration with a nephrology fellowship program. Patients completed a questionnaire derived from the International Society for Peritoneal Dialysis (ISPD) catheter guidelines and were followed for early complications. ♢ RESULTS Approximately 30% of patients reported not being evaluated for hernias, not being asked to visualize their exit site, or not receiving catheter location marking before placement. After insertion, 20% of patients reported not being given instructions for follow-up care, and 46% reported not being taught the warning signs of PDC infection. Directions to manage constipation (57%), immobilize the PDC (68%), or leave the dressing undisturbed (61%) after insertion were not consistently reported. Nearly 40% of patients reported that their PDC education was inadequate. In 41% of patients, a complication developed, with 30% of patients experiencing a catheter or exit-site problem, 11% developing infection, 13% needing PDC revision, and 11% requiring unplanned transfer to hemodialysis because of catheter-related problems. ♢ CONCLUSIONS There were numerous deviations from the ISPD guidelines for PDC placement in the community. Patient satisfaction with education was suboptimal, and complications were frequent. Improving patient education and care coordination for PDC placement were identified as specific quality improvement needs.
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Affiliation(s)
- Leslie P Wong
- Northwest Kidney Centers,1 and Division of Nephrology,2 University of Washington, Seattle, Washington
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67
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Hagen SM, Lafranca JA, Steyerberg EW, IJzermans JNM, Dor FJMF. Laparoscopic versus open peritoneal dialysis catheter insertion: a meta-analysis. PLoS One 2013; 8:e56351. [PMID: 23457554 PMCID: PMC3574153 DOI: 10.1371/journal.pone.0056351] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 01/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Peritoneal dialysis is an effective treatment for end-stage renal disease. Key to successful peritoneal dialysis is a well-functioning catheter. The different insertion techniques may be of great importance. Mostly, the standard operative approach is the open technique; however, laparoscopic insertion is increasingly popular. Catheter malfunction is reported up to 35% for the open technique and up to 13% for the laparoscopic technique. However, evidence is lacking to definitely conclude that the laparoscopic approach is to be preferred. This review and meta-analysis was carried out to investigate if one of the techniques is superior to the other. METHODS Comprehensive searches were conducted in MEDLINE, Embase and CENTRAL (the Cochrane Library 2012, issue 10). Reference lists were searched manually. The methodology was in accordance with the Cochrane Handbook for interventional systematic reviews, and written based on the PRISMA-statement. RESULTS Three randomized controlled trials and eight cohort studies were identified. Nine postoperative outcome measures were meta-analyzed; of these, seven were not different between operation techniques. Based on the meta-analysis, the proportion of migrating catheters was lower (odds ratio (OR) 0.21, confidence interval (CI) 0.07 to 0.63; P = 0.006), and the one-year catheter survival was higher in the laparoscopic group (OR 3.93, CI 1.80 to 8.57; P = 0.0006). CONCLUSIONS Based on these results there is some evidence in favour of the laparoscopic insertion technique for having a higher one-year catheter survival and less migration, which would be clinically relevant.
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Affiliation(s)
- Sander M. Hagen
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jeffrey A. Lafranca
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Frank J. M. F. Dor
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Dupré G, Čoudek K. Laparoscopic-assisted placement of a peritoneal dialysis catheter with partial omentectomy and omentopexy in dogs: an experimental study. Vet Surg 2013; 42:579-85. [PMID: 23373768 DOI: 10.1111/j.1532-950x.2013.01097.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 08/01/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe a technique of laparoscopic-assisted placement of a peritoneal dialysis (PD) catheter with simultaneously performed partial omentectomy and omentopexy. STUDY DESIGN Pilot experimental study. ANIMALS Beagle dogs (n = 6). METHODS After placement of 1 sub-umbilical laparoscope portal and 1 instrument portal in the left cranial abdominal quadrant, laparoscopic-assisted partial omentectomy, and omentopexy were performed, and a modified Tenckhoff PD catheter was placed under laparoscopic guidance. A modified dialysis protocol was used twice daily for 4 days. The feasibility of the procedure, surgical duration, operative complications, and dialysis efficacy were evaluated. Postoperative pain and inflammation were graded (0-3). RESULTS The procedure was successfully performed in all dogs with a median operating time of 25 minutes. No operative complications occurred. Procedure-related postoperative pain and inflammation were minimal. Eight consecutive PD procedures were successfully performed, and no leakage or obstruction was observed. CONCLUSIONS Laparoscopic-assisted partial omentectomy and omentopexy can be performed at the same time as PD catheter placement with minimal morbidity.
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Affiliation(s)
- Gilles Dupré
- Department of Small Animals and Horses, Clinic for Small Animal Surgery, Ophthalmology, Dentistry, Physiotherapy and Rehabilitation, University of Veterinary Medicine Vienna, Vienna, Austria.
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69
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Santarelli S, Zeiler M, Monteburini T, Agostinelli RM, Marinelli R, Degano G, Ceraudo E. Videolaparoscopic catheter placement reduces contraindications to peritoneal dialysis. Perit Dial Int 2012. [PMID: 23209040 DOI: 10.3747/pdi.2011.00314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Videolaparoscopy is considered the reference method for peritoneal catheter placement in patients with previous abdominal surgery. The placement procedure is usually performed with at least two access sites: one for the catheter and the second for the laparoscope. Here, we describe a new one-port laparoscopic procedure that uses only one abdominal access site in patients not eligible for laparotomic catheter placement. METHOD We carried out one-port laparoscopic placement in 21 patients presenting contraindications to blind surgical procedures because of prior abdominal surgery. This technique consists in the creation of a single mini-laparotomy access through which laparoscopic procedures and placement are performed. The catheter, rectified by an introducer, is inserted inside the port. Subsequently, the port is removed, leaving the catheter in pelvic position. The port is reintroduced laterally to the catheter, confirming or correcting its position. Laparotomic placement was performed in a contemporary group of 32 patients without contraindications to blind placement. Complications and long-term catheter outcome in the two groups were evaluated. RESULTS Additional interventions during placement were necessary in 12 patients of the laparoscopy group compared with 5 patients of the laparotomy group (p = 0.002). Laparoscopy documented adhesions in 13 patients, with need for adhesiolysis in 6 patients. Each group had 1 intraoperative complication: leakage in the laparoscopy group, and intestinal perforation in the laparotomy group. During the 2-year follow-up period, laparoscopic revisions had to be performed in 6 patients of the laparoscopy group and in 5 patients of the laparotomy group (p = 0.26). The 1-year catheter survival was similar in both groups. Laparoscopy increased by 40% the number of patients eligible to receive peritoneal dialysis. CONCLUSIONS Videolaparoscopy placement in patients not eligible for blind surgical procedures seems to be equivalent to laparotomic placement with regard to complications and long-term catheter outcome. The number of patients able to receive peritoneal dialysis is substantially increased.
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Gultekin FA, Cakmak GK, Karakaya K, Emre AU, Tascilar O, Oner MO, Comert M, Kulah E. Our long-term results of Tenckhoff peritoneal dialysis catheters placement via laparoscopic preperitoneal tunneling technique. Semin Dial 2012; 26:349-54. [PMID: 23013518 DOI: 10.1111/sdi.12003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Previously we described the technique to lessen complications of continuous ambulatory peritoneal dialysis (CAPD) and to achieve immediate use of the catheter. In this study we evaluated our long-term results of the technique. A total of 61 procedures were carried out in 58 patients from September 2003 to February 2009. All patients were followed in our hospital CAPD clinic. Demographic, medical, operative, postoperative, and other information regarding complications and continued patient management was obtained retrospectively from the patients' medical records and entered into a computerized database. There were 33 men and 25 women. The mean age was 58 years. In 29 of the 58 patients indication of catheter placement was end stage renal failure combined with diabetes mellitus. Mean follow-up time was 33.31 ± 20.11 months. Catheter related complications were outflow obstruction (n=3, 5.2%) and peritonitis (n=2, 3.4%). Etiologies of catheter removal were out flow obstruction (n=2), recovery from renal disease (n=2), peritonitis (n=1), and pregnancy (n=1). The mean catheter survival time was found 5.57 ± 0.17 years. Our long-term results showed that the method ensured accurate placement, preperitoneal fixation, and immediate use of the catheter for routine peritoneal dialysis. Preperitoneal fixation of the catheter decreased outflow obstruction over long-term follow-up.
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Affiliation(s)
- Fatma A Gultekin
- Department of Surgery, School of Medicine, Zonguldak Karaelmas University, Kozlu-Zonguldak, Turkey.
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71
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Xie H, Zhang W, Cheng J, He Q. Laparoscopic versus open catheter placement in peritoneal dialysis patients: a systematic review and meta-analysis. BMC Nephrol 2012; 13:69. [PMID: 22839745 PMCID: PMC3439683 DOI: 10.1186/1471-2369-13-69] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 07/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peritoneal dialysis has been proven to be a safe and effective mode of renal replacement therapy for patients with end-stage renal disease. The usage of laparoscopic catheter placement technique was increased in recent years. But the advantages and disadvantages between the laparoscopic catheter placement technique and open laparotomy technique were still http://in controversy. The objective of this study is to access the operation-related data and complications of catheter placement for peritoneal dialysis (PD) patients, Then to determine the better method for catheter insertion. METHODS We performed a systematic review and meta-analysis on published studies identified by the databases PubMed, EMBASE, Highwire, and the Cochrane Library. Analysis was performed using the statistical software Review Manager Version 5.0. RESULTS We assessed the operation-related data and complications of four randomized controlled trials (RCTs) and ten observational studies. The available data showed that laparoscope prolonged the time for catheter insertion in PD patients, however, the two groups did not significantly differ in hospital stays, early and late complications, including infection, dialysate leaks, catheter migration, pericannular bleeding, blockage and hernia. CONCLUSIONS The data showed that Laparoscopic catheter placement had no superiority to open surgery. However, this treatment still needs to be confirmed in a large, multi-center, well-designed RCT.
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Affiliation(s)
- Haiying Xie
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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72
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A brief recap of tips and surgical manoeuvres to enhance optimal outcome of surgically placed peritoneal dialysis catheters. Int J Nephrol 2012; 2012:251584. [PMID: 22888425 PMCID: PMC3408654 DOI: 10.1155/2012/251584] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 06/11/2012] [Accepted: 06/21/2012] [Indexed: 11/18/2022] Open
Abstract
Background. Peritoneal dialysis (PD) is an effective option of renal replacement therapy for ESRF, offering advantages over haemodialysis. Peritoneal dialysis catheter (PDC) placement is thought to be the key to successful PD and the economic advantages are lost if a patient switches to HD in the 1st year. This paper is a brief document elaborating a recap of published literature, looking at various surgical tips and manoeuvres to enhance optimal outcome of PDC placement. Methods. A search strategy assessing for access team, preoperative antibiotic prophylaxis, type of catheter, catheter exit site, intraoperative catheter trial, optimal time to commence PD, hernia repairs, number of cuffs, catheter-embedding procedures, rectus sheath tunnelling, laparoscopic fixing, omentopexy, omentectomy, the "Y"-Tec system, resection of epiploic appendages, adhesiolysis, a trained surgeon, and perioperative catheter care protocol was used looking at various databases. Findings. The complications of catheterrelated dysfunction can be reduced with advanced planning of access placement, immaculate surgery, and attention to catheter insertion techniques. Conclusion. The success of a peritoneal dialysis programme depends upon functional and durable long term access to the peritoneal cavity; this depends on placement techniques and competent surgeons and psychosocial support to the patient. The various technical tips and manoeuvres elaborated here should be considered options carried out to improve outcome and reduce catheter dysfunction.
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73
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Voss D, Hawkins S, Poole G, Marshall M. Radiological versus surgical implantation of first catheter for peritoneal dialysis: a randomized non-inferiority trial. Nephrol Dial Transplant 2012; 27:4196-204. [PMID: 22810376 DOI: 10.1093/ndt/gfs305] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Voss
- Department of Renal Medicine, Middlemore Hospital, Counties-Manukau District Health Board, Otahuhu, Auckland, New Zealand.
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de Moraes TP, Campos RP, de Alcântara MT, Chula D, Vieira MA, Riella MC, Olandowski M, Divino-Filho JC, Pecoits-Filho R. Similar Outcomes of Catheters Implanted by Nephrologists and Surgeons: Analysis of the Brazilian Peritoneal Dialysis Multicentric Study. Semin Dial 2012; 25:565-8. [DOI: 10.1111/j.1525-139x.2012.01050.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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75
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Shahbazi N, McCormick BB. Peritoneal Dialysis Catheter Insertion Strategies and Maintenance Of Catheter Function. Semin Nephrol 2011; 31:138-51. [DOI: 10.1016/j.semnephrol.2011.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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76
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Burkart J. The future of peritoneal dialysis in the United States: optimizing its use. Clin J Am Soc Nephrol 2010; 4 Suppl 1:S125-31. [PMID: 19995996 DOI: 10.2215/cjn.04760709] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Peritoneal dialysis (PD) has been used to treat patients with stage V chronic kidney disease since 1976. However, despite this long history, as of 2008 <8% of prevalent ESRD patients in the United States are treated with PD, a modality mix that is significantly different from what is seen in other developed countries. Data are reviewed that suggest that the reasons for this seem to be caused by non-medical-related issues such as subtle differences in practice patterns and unintended financial considerations. Medical outcome date would seem to favor more utilization of PD. For instance, data from the USRDS suggested that the relative risk of death for PD versus center hemodialysis has been improving, tending to favor those on PD for longer and longer periods of time. Infectious complications have also been markedly reduced. It is anticipated that changes in government reimbursement, such as the bundling of dialysis-related services, will stimulate a renewed interest in home therapies. Currently most home dialysis units are small, and some have minimal clinical experience with PD. If trends in reimbursement do favor a renewed interest in PD, for patient outcomes on PD to continue to improve, there will likely need to be further educational activities focused on PD, and perhaps, consolidation of PD programs may needed.
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Affiliation(s)
- John Burkart
- Department of Nephrology, Wake Forest University Medical Center, Winston Salem, NC 27157, USA.
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Mettang T, Krumme B, Wilhelm A, Duschka L. Endoscopic Transluminal Insertion of a Peritoneal Dialysis Catheter. Perit Dial Int 2010; 30:63-5. [DOI: 10.3747/pdi.2008.00193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background At present there are various more or less invasive surgical and laparoscopic ways to place a catheter suitable for peritoneal dialysis (PD); however, once the catheter is in place, there is no possibility to inspect the peritoneal cavity without de novo laparotomy or laparoscopy. Patients and Methods To establish a minimally invasive technique and allowing for maximal options, we used a PD catheter with an extra large inside diameter of 3.5 mm. Because of the enlarged inner diameter of 3.5 mm (compared to 2.6 mm in standard Tenckhoff catheters), this device can be passed by a very thin video-endoscope with an external diameter of 2.8 mm. Using a stepwise approach, we applied this device in placing PD catheters in 2 patients. The procedure could be done without complications. Both patients were doing well 4 and 6 months later, respectively, without any PD-related complications. Intraperitoneal view by the endoscope was limited; an attempt to obtain a peritoneal biopsy failed. Conclusions If the drawbacks of this method can be overcome it will have a wide spectrum of applications ( i.e., inspection of the peritoneal cavity and obtaining peritoneal biopsies at any time during PD treatment). In this way it can be used scientifically and clinically when a problem of flow or ultrafiltration occurs or when encapsulating sclerosing peritonitis is suspected.
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Affiliation(s)
- Thomas Mettang
- Department of Nephrology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Bernd Krumme
- Department of Nephrology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Arne Wilhelm
- Department of Surgery, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Lothar Duschka
- Department of Surgery, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
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Keshvari A, Fazeli MS, Meysamie A, Seifi S, Taromloo MKN. The Effects of Previous Abdominal Operations and Intraperitoneal Adhesions on the Outcome of Peritoneal Dialysis Catheters. Perit Dial Int 2010; 30:41-5. [DOI: 10.3747/pdi.2008.00121] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Patients with previous history of abdominal operations are sometimes excluded from consideration for peritoneal dialysis because of concerns for increased risk of complications during the implantation procedure and inadequate dialysis due to reduced peritoneal surface area. Employing a laparoscopic approach, we compared the outcome of peritoneal dialysis catheters in 2 groups of patients with and without intra-abdominal adhesions. Methods All data in this report were recorded prospectively. Revision-free and overall survival of catheters, the incidence of mechanical and infectious complication, and surgical revision rates were compared between the 2 groups. Results In 217 successful catheter implantations, there was a history of previous abdominal surgery in 42.9% of procedures; only 26.9% of them had intraperitoneal adhesions; 2.8% of patients without history of previous abdominal surgery had intraperitoneal adhesions. There were no significant differences between the 2 groups for 1- and 2-year revision-free and overall catheter survival, mechanical dysfunction, infectious complications, or surgical revision rates. Conclusion History of previous abdominal surgery should not be used to judge the eligibility of patients for peritoneal dialysis. Laparoscopic placement is the best way to ensure optimal catheter outcomes equivalent to patients without previous abdominal surgery.
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Affiliation(s)
- Amir Keshvari
- Departments of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alipasha Meysamie
- Community & Prevention Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Seifi
- Nephrology, Tehran University of Medical Sciences, Tehran, Iran
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Regoczi T, Jósvay J, Bálint A, Csaba J, Rákossy W, Fodor E, Kiss I. [Experiences with Tenckhoff peritoneal dialysis catheter]. Orv Hetil 2009; 150:2110-4. [PMID: 19889598 DOI: 10.1556/oh.2009.28747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Peritoneal dialysis is a generally accepted method for the treatment of patients with end-stage renal disease. Two main techniques for the insertion of the peritoneal catheter are known: open surgery and the laparoscopic-assisted technique. AIM To describe our surgical procedure and implantation technique and to determine the outcome of our patients who underwent the conventional and the laparoscopic assisted placement of a catheter. METHODS Between September 2001 and June 2009, 124 patients underwent either conventional or laparoscopic peritoneal dialysis catheter insertion procedure. RESULTS 52 male, and 70 female patients were studied (mean age: 62 years), 110 conventional and 14 laparoscopic assisted operation were done. CONCLUSIONS The traditional method for placement of peritoneal dialysis catheters is by "blind" insertion of the catheter through a small lower abdominal incision. The laparoscopic placement is a new but well-established technique and offers some advantages, such as a safer and accurate placement of the catheter under direct vision, less postoperative pain and complications, and a longer functional survival, compared to the conventional open technique. The functional outcome of the catheters was satisfactory in the majority of patients in this study. The conventional technique is simple, safe and has low costs, and in our opinion, it should be used for the most times, and the laparoscopic technique should be considered as the method of special choice in patients with end-stage chronic renal failure.
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Affiliation(s)
- Tamás Regoczi
- Szent Imre Kórház, Operatív Szakmák Mátrix Szervezete Plasztikai Sebészeti Profil, Budapest.
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Crabtree JH. The Use of the Laparoscope for Dialysis Catheter Implantation: Valuable Carry-On or Excess Baggage? Perit Dial Int 2009. [DOI: 10.1177/089686080902900405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John H. Crabtree
- Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower, California, USA
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81
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Crabtree JH, Burchette RJ. Effective use of laparoscopy for long-term peritoneal dialysis access. Am J Surg 2009; 198:135-41. [PMID: 19306986 DOI: 10.1016/j.amjsurg.2008.10.019] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 10/30/2008] [Accepted: 10/30/2008] [Indexed: 10/21/2022]
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Crabtree JH, Burchette RJ. Effect of Prior Abdominal Surgery, Peritonitis, and Adhesions on Catheter Function and Long-Term Outcome on Peritoneal Dialysis. Am Surg 2009; 75:140-7. [DOI: 10.1177/000313480907500206] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adhesions from previous surgery and peritonitis can lead to peritoneal dialysis catheter insertion failure, visceral injury, and poor dialysis function. Employing a laparoscopic approach, the effect of adhesiolysis on mechanical catheter complications and long-term catheter survival was prospectively examined in 436 catheter placement procedures having a 57.8 per cent prevalence rate of previous surgery. Adhesiolysis was required in 31.8 per cent of cases with prior surgery and in 3.3 per cent of procedures without previous operations. The incidence of adhesiolysis was directly related to the number of prior surgeries ( P < 0.0001). The incidence of catheter insertion failure from extensive adhesions was 1.8 per cent. Survival probability free from catheter obstruction was lower in patients requiring adhesiolysis compared with subjects with prior surgery not requiring adhesiolysis ( P = 0.01). Laparoscopic rescue procedures limited catheter losses from flow obstruction to only 0.7 per cent. As a result, long-term catheter survival was not different among patients regardless of prior surgery and/or adhesion status ( P = 0.2). Scars on the abdomen and prior peritonitis do not predict the extent of adhesions and should not be used to judge eligibility for peritoneal dialysis. Presently, laparoscopy is the only practical way to provide optimal peritoneal access in patients with a history of surgery and peritonitis.
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Affiliation(s)
- John H. Crabtree
- Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower, California
| | - Raoul J. Burchette
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, California
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83
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Ashegh H, Rezaii J, Esfandiari K, Tavakoli H, Abouzari M, Rashidi A. One-Port Laparoscopic Technique for Placement of Tenckhoff Peritoneal Dialysis Catheters: Report of Seventy-Nine Procedures. Perit Dial Int 2008. [DOI: 10.1177/089686080802800613] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Laparoscopic techniques for placement of peritoneal dialysis catheters are becoming increasingly popular. In this paper, we report the results of one-port laparoscopic placement of Tenckhoff catheters in 79 patients in our center. Method Videoscopic monitoring was performed via a port inserted in the left upper quadrant and the catheter was placed via a pull-apart sheath through an incision near the umbilicus. The tip and the deep cuff of the catheter were placed into the true pelvis (on the urinary bladder) and into the rectus sheath respectively. A subcutaneous tunnel was created and a point midway on the umbilico-crestal line was selected as the exit site of the catheter. Catheters were capped for 2 weeks before initiation of peritoneal dialysis. Mean duration of the operation was 25 minutes. Results Four patients died during the follow-up period, all due to other medical problems, and 4 patients underwent renal transplantation. During a 48-month follow-up, catheter-related complications were catheter migration (1.3%; month 1), dialysate leakage (1.3%; month 1), port-site hernia (3.8%; after 6 months), exit-site infection (2.5%; months 1 and 9), and bacterial peritonitis (2.5%; after 6 months). Catheter survival was 97.2% in our series. Conclusion We obtained a low complication rate and a high catheter survival rate with this one-port laparoscopic technique.
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Affiliation(s)
| | | | | | | | | | - Armin Rashidi
- Medical Sciences/ University of Tehran, Tehran, Iran
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84
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Jwo SC, Chen KS, Lee CC, Chen HY. Prospective randomized study for comparison of open surgery with laparoscopic-assisted placement of Tenckhoff peritoneal dialysis catheter--a single center experience and literature review. J Surg Res 2008; 159:489-96. [PMID: 19482306 DOI: 10.1016/j.jss.2008.09.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 08/31/2008] [Accepted: 09/09/2008] [Indexed: 01/30/2023]
Abstract
BACKGROUND The ideal method for catheter placement in patients undergoing peritoneal dialysis remains debatable. This prospective study intends to clarify whether laparoscopic assisted percutaneous puncture is superior to open surgery. MATERIALS AND METHODS From 2002 to 2006, 77 patients receiving first catheter placement were enrolled and randomized to either an open group of 40 patients or a laparoscopic group of 37 patients. Patient characteristics, operation-related data, procedural complications, and clinical outcome were compared by using the statistical software SPSS ver. 11.5 (SPSS, Chicago, IL). RESULTS Laparoscopy had a longer operative time (68.32+/-31.90 versus 46.68+/-15.99 min; P<0.001), shorter wound length (1.69+/-0.46 versus 2.34+/-0.84 cm; P<0.001), and higher costs (P<0.001) compared with open surgery. Laparoscopy tended to have a higher incidence of pericannular bleeding (21.6% versus 7.5%) and a lower rate of early catheter migration (2.7% versus 15.0%), but its early/late/overall complication rate did not statistically differ. No surgical mortality occurred. Rate and cause of overall mortality or catheter dropout did not statistically differ. Catheter longevity was equivalent in both groups. CONCLUSIONS Laparoscopic assisted percutaneous puncture exhibited no superiority to open surgery. As a matter of fact, open surgery's shorter operative time and reduced equipment requirement can increase cost-effectiveness. Therefore, conventional open surgery is recommended for most patients with primary catheter placement.
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Affiliation(s)
- Shyh-Chuan Jwo
- Division of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC.
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85
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Numanoglu A, Rasche L, Roth MA, McCulloch MI, Rode H. Laparoscopic insertion with tip suturing, omentectomy, and ovariopexy improves lifespan of peritoneal dialysis catheters in children. J Laparoendosc Adv Surg Tech A 2008; 18:302-5. [PMID: 18373463 DOI: 10.1089/lap.2007.0100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Over the past two decades, chronic peritoneal dialysis (PD) has emerged as the first choice pediatric dialysis modality. A recent study visually identified the cause of malfunction of PD catheters at the Red Cross Children's Hospital in Cape Town. The reasons that could be found, lead to changed Tenckhoff insertion-techniques from open to laparoscopic. This included suturing of the tip, omentectomy and ovarian-pexy by laparoscopy. In the present paper we prospectively analyzed, if changed insertion technique lead to an improved outcome. PATIENTS AND METHODS 26 Patients required 36 laparoscopic Tenckhoff insertions during the period August of 2003 and July of 2006. Overall a total number of 222.5 catheter-months have been observed. Laparoscopic insertion technique required 3 port placements. The tip of the catheter was sutured to pelvic peritoneum, omentectomy performed through a port site and ovariopexy done when required. RESULTS The mean lifespan of all Tenckhoff's was 6.4 +/- 6.3 months. The tip of the catheter was sutured 20 times, omentectomy done in 9 cases and 6 patients underwent ovarian pexy. In the group where the tip was sutured to the pelvic peritoneum catheter life was 8.4 months compared to the non-sutured group which was only 4.1. Omentectomy lead to an overall catheter survival of 8.0 months compared to the no omentectomy group, which had a survival of 5.8 months. The complication-rate concerning early problems and malfunctions in the sutured and omentectomy groups was also lower. Patients who underwent both, suturing of the tip and omentectomy had no malfunctions at all. CONCLUSION Omentectomy and suturing the tip can lower the complication-rate and prolong catheter survival. Using these procedures could decrease costs and morbidity and prevent patients from having further operations.
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Affiliation(s)
- Alp Numanoglu
- Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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86
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Laparoscopic peritoneal dialysis catheter implantation using a Tenckhoff trocar under local anesthesia with nitrous oxide gas insufflation. Am J Surg 2008; 197:8-13. [PMID: 18571619 DOI: 10.1016/j.amjsurg.2007.10.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 10/10/2007] [Accepted: 10/10/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Laparoscopic implantation of peritoneal dialysis catheters has many advantages over conventional methods. The ability to perform laparoscopy with the patient under local anesthesia allows renal failure patients, who ordinarily might not be considered candidates for general anesthesia, an opportunity to undergo this procedure. METHODS Using local anesthesia and nitrous oxide pneumoperitoneum, 175 catheters were implanted in long musculofascial tunnels under laparoscopic guidance to minimize the risk of catheter migration and flow dysfunction. RESULTS Nitrous oxide pneumoperitoneum was well tolerated, allowing all procedures to be safely completed with the patients under local anesthesia. The overall 1- and 2-year catheter survival rates were 92.7% and 91.3%, respectively. The incidence of catheter tip migration and omental entrapment was 1.7% and 2.9%, respectively. Temporary pericatheter leak occurred in 7.4% of cases. CONCLUSIONS Nitrous oxide insufflation enables safe performance of laparoscopic surgery with the patient under local anesthesia. Patients benefit from a minimally invasive technique with the assurance of obtaining successful long-term catheter function.
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87
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Schmidt SC, Pohle C, Langrehr JM, Schumacher G, Jacob D, Neuhaus P. Laparoscopic-assisted placement of peritoneal dialysis catheters: implantation technique and results. J Laparoendosc Adv Surg Tech A 2008; 17:596-9. [PMID: 17907970 DOI: 10.1089/lap.2006.0162] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Peritoneal dialysis is a generally accepted method for the treatment of patients with end-stage renal failure. The laparoscopic placement of peritoneal dialysis catheters is a well-established technique and offers some advantages, such as a safer placement of the catheter, less post-operative complications, and a longer functional survival, compared to the conventional open technique. The aim of this study was to describe our implantation technique and to determine the results of our approach. PATIENTS AND METHODS Between January 2000 and February 2006, 47 patients with end-stage chronic renal failure underwent a laparoscopic peritoneal dialysis catheter insertion procedure. Perioperative and follow-up data were collected prospectively. RESULTS The mean operating time was 35 minutes (range, 16-100). There was no perioperative morbidity. Nine (19.1%) patients experienced 10 mechanical complications: fluid leakage in 6 (12.8%) patients, acute hydrothorax in 1 (2.1%), catheter tip migration in 2 (4.3%), and catheter obstruction in 1 (2.1%) patient. Episodes of peritonitis were observed in 5 (10.6%) patients. One (2.1%) patient developed a catheter infection. In 3 (6.4%) patients, a port site hernia occurred that required surgical repair, 5 (10.6%) patients underwent laparoscopic revisions owing to mechanical complications, 9 (19.1%) patients underwent renal transplantation, and 6 (12.8%) patients died during the later follow-up. After a mean follow-up time of 17 months (range, 2-76), 30 (63.8%) catheters are still in use for dialysis. CONCLUSIONS The functional outcome of the dialysis catheters was satisfactory in the majority of patients in this study. The described technique for catheter implantation is simple and safe, and in our opinion, the laparoscopic technique should be considered as the method of choice in patients with end-stage chronic renal failure.
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Affiliation(s)
- Sven C Schmidt
- Clinic for General-, Visceral-, and Transplantation Surgery, Charité Campus Virchow-Klinikum, University Medicine Berlin, Berlin, Germany.
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88
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Vascular Access for Dialysis, Chemotherapy, and Nutritional Support. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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89
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McCormick BB, Bargman JM. Noninfectious Complications of Peritoneal Dialysis: Implications for Patient and Technique Survival: Table 1. J Am Soc Nephrol 2007; 18:3023-5. [PMID: 18003770 DOI: 10.1681/asn.2007070796] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Brendan B McCormick
- Division of Nephrology, Kidney Research Center, and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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90
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Crabtree JH. Previous abdominal surgery is not necessarily a contraindication for peritoneal dialysis. ACTA ACUST UNITED AC 2007; 4:16-7. [DOI: 10.1038/ncpneph0669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 10/01/2007] [Indexed: 11/09/2022]
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91
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Abstract
Many burdensome interventions that adversely affect the utilization of peritoneal dialysis as renal replacement therapy and patient satisfaction with this treatment modality can be avoided by early peritoneal access placement with embedded catheters, implantation techniques that preempt common catheter complications, and the use of access devices that provide flexibility in exit site location. Catheter embedding consists of subcutaneously burying the external limb of the catheter tubing at the time of the insertion procedure. Interval exteriorization of the catheter is performed when dialysis is needed. Earlier commitment by patients to peritoneal dialysis can be achieved by elimination of catheter maintenance until dialysis is necessary. Catheter embedding is a practical strategy to avoid temporary hemodialysis with vascular catheters and reduces stress on operating room access by allowing more efficient scheduling as non-urgent procedures. Laparoscopic catheter placement enables proactive techniques not available to other conventional insertion methods. These techniques include rectus sheath tunneling to prevent catheter tip migration, selective prophylactic omentopexy to prevent omental entrapment, selective resection of epiploic appendages to prevent catheter obstruction, adhesiolysis to eliminate compartmentalization, and diagnosis and simultaneous repair of previously undiagnosed abdominal wall hernias. Both standard and extended 2-piece catheter systems are necessary to customize the peritoneal access to a variety of body configurations. Catheters should be able to produce lower abdominal, mid-abdominal, upper abdominal, and upper chest exit site locations that facilitate management by the patient without sacrificing deep pelvic position of the catheter tip or resulting in excessive tubing stress during passage through the abdominal wall.
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Affiliation(s)
- J H Crabtree
- Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower, CA 90706, USA.
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92
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Abstract
In recent years, there have been some interesting advances in the science and practice of peritoneal dialysis (PD). This review focuses on selected technological advances and the impact that these changes may have on this modality. New, so-called "biocompatible" fluids have more physiologic pH and reduced glucose degradation products. These new fluids may reduce the deleterious effects of chronic exposure to the peritoneal membrane. However, enthusiasm for these new fluids is outstripping rigorous evidence that they change patient outcome. Continuous-flow PD offers a way to increase dramatically small solute clearance. However, there are significant technological barriers to the implementation of this kind of dialysis. Furthermore, there is little evidence that augmented small solute clearance will improve survival in PD patients. Finally, new catheter insertion techniques provide perhaps the most practical advances in allowing successful commencement of this excellent home dialysis modality.
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93
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McCormick BB, Brown PA, Knoll G, Yelle JD, Page D, Biyani M, Lavoie S. Use of the embedded peritoneal dialysis catheter: Experience and results from a North American Center. Kidney Int 2006:S38-43. [PMID: 17080110 DOI: 10.1038/sj.ki.5001914] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since 2000, the Ottawa Hospital Home Dialysis Program has used a variation on the embedded peritoneal dialysis catheter technique described by Moncrief et al. In this paper, we describe our approach to placement of peritoneal access and report our experience with 304 embedded catheters placed between January 2000 and December 2003. We review the advantages and disadvantages of this technique and describe factors that have been important to the success of our program.
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Affiliation(s)
- B B McCormick
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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94
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Crabtree JH, Burchette RJ, Siddiqi NA. Optimal Peritoneal Dialysis Catheter Type and Exit Site Location: An Anthropometric Analysis. ASAIO J 2005; 51:743-7. [PMID: 16340361 DOI: 10.1097/01.mat.0000179786.01967.57] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
An anthropometric analysis of 200 adult patients was performed to provide better guidance in catheter selection and placement. Height, weight, various abdominal wall measurements, and gender effects were analyzed. Suitability of Tenckhoff catheters with straight and preformed bends in the intercuff segment was evaluated regarding ability to produce deep pelvic position of the catheter tip and ideal exit site location. Conflicts with belt line and with skin creases and folds were recorded. Results showed that abdominal wall measurements varied widely by height and weight. Swan neck catheters with a downwardly directed external limb and exit site were significantly better suited for females (62% versus 27%, p < 0.0001). Tenckhoff catheters with straight intercuff segments with a laterally directed tunnel tract and exit site were significantly better matched to males (78% versus 30%, p < 0.0001). Neither catheter was suitable in 25% of subjects, emphasizing the need for an extended catheter system capable of remotely locating the exit site to the upper abdomen or chest without compromising pelvic position of the catheter tip. Appropriate preoperative evaluation with selection of the best suited catheter should replace the substandard practice of using a pet catheter to fit all patients and rigidly placing the insertion incision at a set location irrespective of body habitus.
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Affiliation(s)
- John H Crabtree
- Department of Surgery, Southern California Permanente Medical Group, Kaiser Permanente Bellflower Medical Center, Bellflower, CA 90706, USA.
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