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Obaid O, Torres-Ruiz T, Nazzal M, Wandtke Barber M, Rodriguez-Silva F, Dash S, Al-Jalodi O, Young A, Sferra J. Inpatient peritoneal dialysis catheters placed across the United States during a 3-year period: Lessons learned from 15,000 patients. Surgery 2024; 175:877-884. [PMID: 37953138 DOI: 10.1016/j.surg.2023.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Peritoneal dialysis is a popular option for patients with end-stage renal disease. A recent presidential executive order has incentivized in-home end-stage renal disease treatments, leading to an increase in peritoneal dialysis use. Guidelines exist for creating and maintaining peritoneal dialysis access without addressing the optimal technique. This study evaluates nationwide peritoneal dialysis catheter placement practices and their long-term outcomes. METHODS Retrospective cohort analysis of Nationwide Readmission Database from 2017 to 2019. Patients with end-stage renal disease undergoing inpatient peritoneal dialysis catheter placement were included. Six-month readmissions, mortality, and peritoneal dialysis catheter-specific outcome measures were assessed among survivors of admission, including catheter leakage, mechanical breakdown, displacement, revision or replacement, removal, exit site infections, intra-abdominal abscess, and sepsis. Binary logistic regression analyses were performed. RESULTS In the study, 14,863 patients with inpatient peritoneal dialysis catheter insertions were identified, of which 7,096 were analyzed (4,150 [59%] laparoscopic, 1,781 [25%] fluoroscopic, 1,165 [16%] open), 847 (12%) had major complications, 931 (13%) were readmitted, and 102 (1.4%) died within 6 months. Univariate analyses demonstrated that laparoscopy had higher mechanical complications, exit-site infections, catheter revision, and removal within 6 months, and fluoroscopy had higher sepsis and mortality. Multivariate analyses showed fluoroscopy was associated with intraabdominal abscess (adjusted odds ratio, 2.36; P = .025), laparoscopy with exit-site infections (adjusted odds ratio, 0.49; P = .005), and open surgery with catheter displacement (adjust odds ratio, 2.95; P = .021). CONCLUSION This is the first large-scale study on inpatient peritoneal dialysis catheter placement outcomes in the United States. Fluoroscopic and open surgical placements are routinely performed, but laparoscopy remains the mainstay with fewer exit-site infections. Overall, peritoneal dialysis is a safe option, with 1 in 9 patients having an infectious or mechanical complication within 6 months. Furthermore, large-scale prospective studies are warranted to identify the optimal placement technique.
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Affiliation(s)
- Omar Obaid
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | - Tania Torres-Ruiz
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH; Department of Surgery, Toledo Hospital, Promedica Health System, OH
| | - Munier Nazzal
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | - Meghan Wandtke Barber
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | | | - Siddhartha Dash
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | - Omar Al-Jalodi
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | - Alexander Young
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | - Joseph Sferra
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH; Department of Surgery, Toledo Hospital, Promedica Health System, OH.
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Efficacy of dexmedetomidine on peritoneal dialysis catheter insertion. Int Urol Nephrol 2021; 54:209-215. [PMID: 34143371 DOI: 10.1007/s11255-021-02916-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Dexmedetomidine (DEX) is a sedative agent with minimal respiratory and hemodynamic effects. The present study aimed to evaluate its effectiveness in peritoneal dialysis (PD) catheter insertion. METHODS This single-center retrospective study included patients who underwent PD catheter insertion under spinal anesthesia in our hospital between January 2016 and December 2020. Patients were divided into the DEX and non-DEX groups according the use of DEX. After 1:1 propensity score matching to adjust for age, sex, body mass index, mean blood pressure (BP), and Charlson comorbidity index, we compared operation-related outcomes, including peak numerical rating scale (NRS), occurrence of nausea, vital signs, or operative time between the two groups. RESULTS Of a total of 44 patients, 9 patients received DEX, and 35 did not. After propensity score matching, each group consisted of 8 patients. Peak NRS was significantly lower (P = 0.003) in the DEX group compared with the non-DEX group. Maximum mean BP during the operation was also significantly lower in the DEX group compared with the non-DEX group (P = 0.020), with no significant differences in minimum mean BP between the two groups (P = 0.831). The DEX group showed a trend of shortened operative time (P = 0.068). There were no significant differences in the occurrence of nausea (P = 1.000). Moreover, there was no clinically important adverse event associated with use of DEX. CONCLUSION The use of DEX in PD catheter insertion under spinal anesthesia could safely improve operative analgesia.
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Li J, Guo W, Zhao W, Wang X, Hu W, Zhou J, Xu S, Lei H. Ultrasound-Guided Unilateral Transversus Abdominis Plane Combined with Rectus Sheath Block versus Subarachnoid Anesthesia in Patients Undergoing Peritoneal Dialysis Catheter Surgery: A Randomized Prospective Controlled Trial. J Pain Res 2020; 13:2279-2287. [PMID: 32982391 PMCID: PMC7500835 DOI: 10.2147/jpr.s264255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022] Open
Abstract
Background Peritoneal dialysis catheter placement can be performed under general anesthesia, local anesthesia or subarachnoid anesthesia (SA). Recently, studies have reported the successful placement of peritoneal dialysis catheters using a transversus abdominis plane (TAP) block and rectus sheath (RS) block. This study compared the TAP + RS block with SA for patients undergoing peritoneal dialysis catheter placement. Methods Sixty patients were randomly divided into two groups, with 30 receiving unilateral ultrasound-guided TAP + RS block anesthesia and 30 receiving SA. The demographic characteristics, anesthesia efficacy, indicators related to anesthesia or operation, hemodynamic index, postoperative pain numeric rating score (NRS), postoperative recovery indicators, complications related to anesthesia or surgery, and dosage of sedative or analgesic medication were analyzed. Results Anesthesia operation time was significantly shorter in the TAP + RS block group than in the SA group (P<0.001), while there was no significant difference in success rates (TAP + RS 93.33% [95% confidence interval, 95% CI, 83.9–102.8%] vs SA 100.00% [95% CI, 100–100%], P=0.472). Two patients in the TAP + RS group needed extra analgesia, although the dermatome pinprick sensation test gave negative results for all patients. Patients who received the TAP + RS block expressed significantly less pain on movement or at rest at 4 h and 8 h postoperative. Fewer patients needed rescue analgesia with tramadol in the postoperative period in the TAP + RS block group than in the SA group (P<0.05). The intraoperative MAP was more stable (P<0.05) in the TAP + RS group compared to the SA group. Conclusion The TAP + RS block is a safe, effective method for use as the principal anesthesia technique in PD catheter placement. Compared to SA, it has the advantages of less influence on hemodynamics and a better postoperative analgesic effect.
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Affiliation(s)
- Ji Li
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wenjing Guo
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wei Zhao
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xiang Wang
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wenmin Hu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Jie Zhou
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shiyuan Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Hongyi Lei
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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Maio R, Figueiredo N, Costa P. Laparoscopic Placement of Tenckhoff Catheters for Peritoneal Dialysis: A Safe, Effective, and Reproducible Procedure. Perit Dial Int 2020. [DOI: 10.1177/089686080802800213] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background/AimsCurrently there are several techniques for laparoscopic placement of peritoneal dialysis catheters. The aim of this paper is to describe our technique and outcomes.Patients and MethodsLaparoscopic implantation of peritoneal catheters was performed in 100 consecutive patients. The technique employed laparoscopically guided mus-culofascial tunneling to maintain catheter orientation toward the deep pelvis, and adhesiolysis to eliminate compartmentalization that could affect completeness of dialysate drainage. Mean duration of surgery, hospital stay, morbidity, mortality, and catheter survival were assessed. Analysis of catheter survival was performed using the Kaplan–Meier method, with censoring of catheter loss due to death or successful transplantation.ResultsMean operative time was 20 ± 7 minutes and average duration of hospital stay was 3 ± 1 days. There were no conversions from laparoscopy to conventional catheter insertion methods. No exit-site or tunnel infections, hemorrhagic complications, abdominal wall hernias, or catheter cuff extrusions were detected. No mortality occurred in this series of patients. Catheter survival was 97%, 95%, and 91% at 1, 2, and 3 years, respectively.ConclusionsThe laparoscopic method described in this report is compliant with consensus guidelines for best-demonstrated practices in peritoneal access placement. Laparoscopy permits direct visualization of all procedure steps in a safe efficient reproducible manner. The laparoscopic approach afforded patients the advantage of short procedure times, a minimally invasive approach, and excellent outcomes. The results reported in this paper support our opinion that laparoscopic Tenckhoff catheter implantation should become the standard of care for clinical practice.
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Affiliation(s)
- Rui Maio
- Serviço de Cirurgia I, Hospital Universitário de Santa Maria, Lisbon, Portugal
| | - Nuno Figueiredo
- Serviço de Cirurgia I, Hospital Universitário de Santa Maria, Lisbon, Portugal
| | - Paulo Costa
- Serviço de Cirurgia I, Hospital Universitário de Santa Maria, Lisbon, Portugal
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Prabhakar N, Aljamal YN, Saleem HY, Baloul MS, Nyberg SL, Farley DR. Outcomes of laparoscopic and open CAPD catheter placement: A single-center experience. Surg Open Sci 2019; 1:20-24. [PMID: 32754688 PMCID: PMC7391912 DOI: 10.1016/j.sopen.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 11/26/2022] Open
Abstract
Background Continuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement is typically a straightforward surgical procedure performed on chronically ill patients with end-stage renal disease (ESRD). Post-operative outcomes and reoperative rates vary greatly in the medical literature. We report our experience using both minimally invasive and open techniques in placing CAPD catheters and offer our surgical outcomes. Methods This study is an IRB-approved, retrospective review (2005–2018) of all patients undergoing CAPD catheter placement at Mayo Clinic-Rochester. Analysis focused on specific patient outcomes, including early (< 30 days) versus late (≥ 30 days) complication and reoperation rates. Results A total of 173 patients with ESRD (mean ASA score = 3.1) underwent laparoscopic (n = 22) and open (n = 151) CAPD catheter placement (mean follow-up = 309 days; range: 1–3497 days). The total index operation complication rate was 41%. The total index reoperation rate was 37% and was similar in open and laparoscopic approaches. CAPD catheters malfunctioned in 19 patients (11% of total) and each underwent reoperation. CAPD catheter infections occurred in 30 patients (17% of total), and 24 required reoperation; 6 patients were treated successfully with antibiotics. CAPD catheter migrations occurred in 21 patients (12% of total) and all underwent reoperation. Conclusion Although CAPD catheter placements in patients with ESRD are technically easy to accomplish, the long term outcomes suggest as many as one in three patients will struggle with catheter function or infection. This study has led to changes in our technical CAPD catheter placement procedures, as well as the post-operative patient care algorithm. Open CAPD catheter placement is faster than using a laparoscopic approach One in 3 patients with CAPD catheters will struggle with tube dysfunction or infection Laparoscopic CAPD catheter placement is technically easy to perform
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Shrestha BM, Shrestha D, Kumar A, Shrestha A, Boyes SA, Wilkie ME. Advanced Laparoscopic Peritoneal Dialysis Catheter Insertion: Systematic Review and Meta-Analysis. Perit Dial Int 2018; 38:163-171. [PMID: 29848597 DOI: 10.3747/pdi.2017.00230] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/20/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The optimal methodology of establishing access for peritoneal dialysis (PD) remains controversial. Previously published randomized controlled trials and cohort studies do not demonstrate an advantage for 1 technique over another. Four published meta-analyses comparing outcomes of laparoscopic versus open PD catheter (PDC) insertion have given inconsistent conclusions and are flawed since they group basic and advanced laparoscopy together. The aim of this systematic review and meta-analysis is to examine whether advanced laparoscopic interventions consisting of rectus sheath tunneling and adjunctive procedures produce a better outcome than open insertion or basic laparoscopy used only to verify the catheter position. METHODS A literature search using Medline, Embase, and Cochrane Database was performed, and meta-analysis was performed using RevMan 5.3.5 software (Nordic Cochrane Centre, The Cochrane Collaboration, London, UK). Outcomes evaluated incidence of catheter obstruction, migration, pericannular leak, hernia, infectious complications (peritonitis and exit-site infection) and catheter survival. RESULTS Of the 467 records identified, 7 cohort studies, including 1,045 patients, were included in the meta-analysis. When advanced laparoscopy was compared with open insertion, a significant reduction was observed in the incidence of catheter obstruction (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.03 - 0.63; p = 0.01), catheter migration (OR 0.12, 95% CI 0.06 - 0.26; p = 0.00001), pericannular leak (OR 0.27, 95% CI 0.11 - 0.64; p = 0.003), and pericannular and incisional hernias (OR 0.29, 95% CI 0.09 - 0.94; p = 0.04), as well as better 1- and 2-year catheter survival (OR 0.52, 95% CI 0.28 - 0.97; p = 0.04 and OR 0.50, 95% CI 0.28 - 0.92; p = 0.03, respectively). Compared with basic laparoscopy, catheter obstruction and migration were significantly lower in the advanced laparoscopic group, whereas catheter survival was similar in both groups. All outcomes, except catheter obstruction, were similar between the basic laparoscopy and open insertion. The infectious complications such as peritonitis and exit-site infections were similar between the 3 groups. CONCLUSIONS Advanced laparoscopy was associated with a significant superior outcome in comparison with open insertion and basic laparoscopy.
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Affiliation(s)
- Badri M Shrestha
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom
| | - Donna Shrestha
- North Manchester General Hospital, Manchester, United Kingdom
| | - Avneesh Kumar
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom
| | | | - Simon A Boyes
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom
| | - Martin E Wilkie
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom
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van Laanen JHH, Cornelis T, Mees BM, Litjens EJ, van Loon MM, Tordoir JHM, Peppelenbosch AG. Randomized Controlled Trial Comparing Open Versus Laparoscopic Placement of a Peritoneal Dialysis Catheter and Outcomes: The CAPD I Trial. Perit Dial Int 2018; 38:104-112. [PMID: 29386303 DOI: 10.3747/pdi.2017.00023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 10/16/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine the best operation technique, open versus laparoscopic, for insertion of a peritoneal dialysis (PD) catheter with regard to clinical success. Clinical success was defined as an adequate function of the catheter 2 - 4 weeks after insertion. METHODS All patients with end-stage renal disease who were suitable for PD and gave informed consent were randomized for either open surgery or laparoscopic surgery. A previous laparotomy was not considered an exclusion criterion. Laparoscopic placement had the advantage of pre-peritoneal tunneling, the possibility for adhesiolysis, and placement of the catheter under direct vision. Catheter fixation techniques, omentopexy, or other adjunct procedures were not performed. Other measured parameters were in-hospital morbidity and mortality and post-operative infections. RESULTS Between 2010 and 2016, 95 patients were randomized to this study protocol. After exclusion of 5 patients for various reasons, 44 patients received an open procedure and 46 patients a laparoscopic procedure. Gender, age, body mass index (BMI), hypertension, current hemodialysis, severe heart failure, and previous an abdominal operation were not significantly different between the groups. However, in the open surgery group, fewer patients had a previous median laparotomy compared with the laparoscopic group (6 vs 16 patients; p = 0.027). There was no statistically significant difference in mean operation time (36 ± 24 vs 38 ± 15 minutes) and hospital stay (2.1 ± 2.7 vs 3.1 ± 7.3 days) between the groups. In the open surgery group 77% of the patients had an adequate functioning catheter 2 - 4 weeks after insertion compared with 70% of patients in the laparoscopic group (p = not significant [NS]). In the open surgery group there was 1 post-operative death (2%) compared with none in the laparoscopic group (p = NS). The morbidity in both groups was low and not significantly different. In the open surgery group, 2 patients had an exit-site infection and 1 patient had a paramedian wound infection. In the laparoscopic group, 1 patient had a transient cardiac event, 1 patient had intraabdominal bleeding requiring reoperation, and 1 patient had fluid leakage that could be managed conservatively. The survival curve demonstrated a good long-term function of PD. CONCLUSION This randomized controlled trial (RCT) comparing open vs laparoscopic placement of PD catheters demonstrates equal clinical success rates between the 2 techniques. Advanced laparoscopic techniques such as catheter fixation techniques and omentopexy might further improve clinical outcome.
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Affiliation(s)
- Jorinde H H van Laanen
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tom Cornelis
- Jessa Hospital, Department of Nephrology, Hasselt, Belgium
| | - Barend M Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elisabeth J Litjens
- Department of Internal Medicine, Division of Nephrology Maastricht University Medical Center, Maastricht, The Netherlands
| | - Magda M van Loon
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan H M Tordoir
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arnoud G Peppelenbosch
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Tullavardhana T, Akranurakkul P, Ungkitphaiboon W, Songtish D. Surgical versus percutaneous techniques for peritoneal dialysis catheter placement: A meta-analysis of the outcomes. Ann Med Surg (Lond) 2016; 10:11-8. [PMID: 27489619 PMCID: PMC4961679 DOI: 10.1016/j.amsu.2016.07.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 11/18/2022] Open
Abstract
Background Peritoneal dialysis (PD) is an effective method of renal replacement therapy for end-stage renal disease patients. The PD catheter could be inserted by surgical (open surgery/laparoscopic-assisted) or percutaneous techniques. However, the efficacy of the techniques, including catheter survival and catheter related complications, is still controversial. Method The dataset was defined by searching PubMed, EMBASE, Google Scholar and the Cochrane database that had been published until July 2014. The meta-analysis was performed using Review Manager Software version 5.2.6. Result The final analysis was conducted on 10 studies (2 randomized controlled studies (RCTs) and 8 retrospective studies), including 1626 patients. The pooled data demonstrate no significant difference in 1-year catheter survival (OR = 1.04, 95% CI = 0.52–2.10, P = 0.90) between surgical and percutaneous groups. However, the sensitivity analysis of the RCTs demonstrated that the incidence of overall infectious (OR = 0.26, 95% CI = 0.11–0.64, P = 0.003) and overall mechanical complications (OR = 0.32, 95% CI = 0.15–0.68, P = 0.003) were significantly lower in the percutaneous groups than the surgical groups. Furthermore, the subgroup analyses revealed no significant difference in the rates of peritonitis, tunnel and exit site infection, leakage, inflow-outflow obstruction, bleeding and hernia by comparing the methods. Conclusion The results showed that the placement modality did not affect 1-year catheter survival. Percutaneous catheter placement is as safe and effective as surgical technique. Peritoneal dialysis (PD) is an effective and less costly method of renal replacement therapy for end-stage renal disease patients (ESRD). Peritoneal dialysis is more effective in preserves renal function while awaiting renal transplantation, faster restoration of diuresis and better quality of life as a home treatment than hemodialysis. Currently, there is no consensus for preferring type of catheter and the catheter placement method because of each modality has its pros, cons, and post-operative complication. Thus, the authors performed a meta-analysis an attempt to clarify the comparison of the outcomes of both techniques (such as a 1-year catheter survival, infectious complication, and mechanical complication).
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Affiliation(s)
- Thawatchai Tullavardhana
- Corresponding author. Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok 26120, Thailand.
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Qiao Q, Zhou L, Hu K, Xu D, Li L, Lu G. Laparoscopic versus traditional peritoneal dialysis catheter insertion: a meta analysis. Ren Fail 2016; 38:838-48. [DOI: 10.3109/0886022x.2015.1077313] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Cox TC, Blair LJ, Huntington CR, Prasad T, Kercher KW, Heniford BT, Augenstein VA. Laparoscopic versus open peritoneal dialysis catheter placement. Surg Endosc 2015; 30:899-905. [DOI: 10.1007/s00464-015-4297-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/29/2015] [Indexed: 01/30/2023]
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Peppelenbosch A, van Kuijk WHM, Bouvy ND, van der Sande FM, Tordoir JHM. Peritoneal dialysis catheter placement technique and complications. NDT Plus 2015; 1:iv23-iv28. [PMID: 25983982 PMCID: PMC4421142 DOI: 10.1093/ndtplus/sfn120] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 06/19/2008] [Indexed: 02/06/2023] Open
Abstract
Background. This review describes the peritoneal dialysis (PD) catheter implantation techniques for the treatment of PD. The PD catheter-related complications still cause significant morbidity and mortality, resulting in the necessity to switch to haemodialysis (HD) treatment. Methods. Several catheter insertion techniques, using an open surgical approach, laparoscopic and percutaneous techniques have been employed, with their specific early and late complications and failure rates. Results. Despite the similar outcomes of open surgical versus laparoscopic techniques from randomized studies, the laparoscopic insertion has the major advantage of correct catheter positioning in the lower abdomen, with the possibility of adhesiolysis. The minimal invasive percutaneous insertion bears the risk of bowel perforation and catheter malpositioning, and the outcome of this technique is strongly related to the experience of the surgeon. The major complications of these implantation techniques, like bleeding, dialysate leakage and catheter malpositioning, and their management are discussed in our study. Late peritonitis remains the major drawback of PD treatment, with the need of temporary or permanent changeover to the HD treatment in 10% of the patients. Conclusions. Enrichment of the physician's interest and experience, along with a multidisciplinary approach to outline the optimal strategy of PD-catheter insertion and complication of the treatment, may improve the patients' survival and decrease the morbidity.
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Park YS, Min SI, Kim DK, Oh KH, Min SK, Kim SM, Ha J. The outcomes of percutaneous versus open placement of peritoneal dialysis catheters. World J Surg 2014; 38:1058-64. [PMID: 24305922 DOI: 10.1007/s00268-013-2346-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peritoneal dialysis catheters (PDCs) can be inserted by a percutaneous, open surgical, or laparoscopic approach. Considerable controversy surrounds the mode of catheter placement and its impact on technical success. We compared the complications and survival characteristics of PDCs that were inserted by the open approach versus those inserted percutaneously. METHODS We reviewed the outcomes of 167 patients who received PDCs between September 2009 and February 2012. Of these, 89 were placed percutaneously and 78 were placed by open surgical techniques. The mechanical complication rates, including catheter bleeding, wrapping, migration, leakage, and technical failure of intraperitoneal placement were compared between the two groups. Additionally, peritonitis episodes, exit site infection rates, and tunnel infection rates were compared between groups. RESULTS The incidence of one or more previous intra-abdominal surgeries was significantly higher in the open group (4.5 percutaneous vs 21.7 % open; P = 0.001). Although the overall number of complications did not differ between the two groups, the incidence of early mechanical complications (11.2 vs 0 %; P = 0.002) and the number of catheter removals due to mechanical complications (7.9 vs 1.3 %; P = 0.047) were higher in the percutaneous group. Of the 15 mechanical complications in the percutaneous group, one third were due to technical failures compared to none in the open group (5.6 vs 0 %; P = 0.034). The 1 year survival rate of the PDCs for the percutaneous and open groups was 89.9 and 93.3 %, respectively (P = 0.249). CONCLUSIONS The placement modality did not affect catheter survival. However, early mechanical complications, including technical failures, were more frequent in the percutaneous group, despite the proportion of patients with a history of one or more previous intra-abdominal surgeries being significantly lower in that group. The direct visualized open method of catheter insertion may provide the most reliable and secure access for a PDC.
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Affiliation(s)
- Young Suk Park
- Department of General Surgery, Seoul National University Hospital, Seoul, South Korea,
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Maheshwari PN, Heda RS, Oswal AT, Wagholikar G, Rao N, Maheshwari SP. Laparoscopy-assisted Continuous Ambulatory Peritoneal Dialysis Catheter Placement Using Amplatz Dilators: A New Technique With Results. Urology 2014; 84:1521-4. [DOI: 10.1016/j.urology.2014.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/29/2014] [Accepted: 08/26/2014] [Indexed: 12/21/2022]
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Zhu W, Jiang C, Zheng X, Zhang M, Guo H, Yan X. The placement of peritoneal dialysis catheters: a prospective randomized comparison of open surgery versus "Mini-Perc" technique. Int Urol Nephrol 2014; 47:377-82. [PMID: 25395078 DOI: 10.1007/s11255-014-0877-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/01/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE Currently, most ESRD patients are treated with open surgical technique or with laparoscopic technique. In this study, we examined the role of the ureteroscope-assisted "Mini-Perc" technique versus the modified open surgery in the treatment of ESRD in a prospective randomized manner. METHODS A total of 72 patients with chronic renal failure were prospectively randomized for the ureteroscope-assisted "Mini-Perc" technique or modified open surgery. Intraoperative and postoperative morbidity, incision size, dose of local anesthesia, operative time, hospital stay, and initial catheter survival and follow-up were compared for both methods. RESULTS "Mini-Perc" group was associated with shorter incision size, operative time, and hospital stay, with lower dose of local anesthesia and incidence of bloody ascites. Two of five patients with the history of abdominal surgery in "Mini-Perc" group required adhesiolysis under direct vision of telescope. All adhesions were easily dissected. All complications of leakage (8.1 %) and incisional hernia (2.7 %) occurred in the open surgery group, but a difference of no significant value with "Mini-Perc" group (p = 0.2400, p = 1.0000). There was no any other significant difference in common complications between two groups. After 2 years of follow-up, 54 patients (75 %) survived with their initial PD catheter. The overall death was 5 (6.9 %). CONCLUSIONS Compared to modified open surgical technique, the ureteroscope-assisted "Mini-Perc" technique can be used to achieve the same clinical efficacy for placement of peritoneal dialysis catheters in ESRD patients, and it carries minimal morbidity.
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Affiliation(s)
- Wei Zhu
- Department of Nephrology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
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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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A modified method in laparoscopic peritoneal catheter implantation: the combination of preperitoneal tunneling and pelvic fixation. ISRN SURGERY 2013; 2013:248126. [PMID: 23762625 PMCID: PMC3671265 DOI: 10.1155/2013/248126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/04/2013] [Indexed: 12/02/2022]
Abstract
Introduction. Continuous ambulatory peritoneal dialysis (CAPD) is widely accepted for the management of end-stage renal disease (ESRD). Although not as widely used as hemodialysis, CAPD has clear advantages, especially those related to patient satisfaction and simplicity. Peritoneal dialysis (PD) catheter insertion can be accomplished by several different techniques. In this study, we aimed to evaluate our results obtained with peritoneal dialysis catheter placement by combination of pelvic fixation plus preperitoneal tunneling. Material and Methods. Laparoscopic peritoneal catheter implantation by combining preperitoneal tunneling and pelvic fixation methods was performed in 82 consecutive patients with end-stage renal disease. Sex, age, primary disease etiology, complications, mean duration of surgery, mean duration of hospital stay, morbidity, mortality, and catheter survival rates and surgical technique used were assessed. Analysis of catheter survival was performed using the Kaplan-Meier method. Results. Mean follow-up period was 28.35 ± 14.5 months (range of 13–44 months). Mean operative time was 28 ± 6 minutes, and mean duration of hospital stay was 3 ± 1 days. There were no conversions from laparoscopy to other insertion methods. None of the patients developed serious complications during surgery or the postoperative period. No infections of the exit site or subcutaneous tunnel, hemorrhagic complications, abdominal wall hernias, or extrusion of the superficial catheter cuff was detected. No mortality occurred in this series of patients. Catheter survival was found to be 92% at 3 years followup. Conclusions. During one-year followup, we had seven patients of migrated catheters due to separation of pelvic fixation suture from peritoneal surface, but they were reimplanted and fixated again laparoscopically with success. Over a three-year followup period, catheter survival was found to be 92%. In the literature, similar catheter survival rates without combination of the two techniques are reported. As a conclusion, although laparoscopic placement of PD catheters avoids many perioperative and early complications, as well as increasing catheter free survival period and quality of life, our results comparing to other studies in the literature indicate that different laparoscopic placement methods are still in debate, and further studies are necessary to make a more accurate decision.
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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: 50] [Impact Index Per Article: 4.5] [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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Bunker D, Ilie V, Fisher D. Laparoscopic Tenckhoff catheter insertion: a retrospective study over 6 years. ANZ J Surg 2012; 84:73-7. [PMID: 22985018 DOI: 10.1111/j.1445-2197.2012.06273.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2012] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Peritoneal dialysis via Tenckhoff catheter predisposes to hernia formation due to both local and systemic factors. Another important complication of peritoneal catheter insertion includes infection, which can prompt removal of the catheter. METHODS We performed a retrospective study between January 2005 and July 2011 of 61 patients who underwent laparoscopic placement of a Tenckhoff catheter and peritoneal dialysis at our institution using a single-port technique. We analysed complications of Tenckhoff insertion, specifically infection and the formation of hernias requiring operative management. RESULTS Infections noted in our patients included peritonitis (10%) and exit-site infection (5%). Of the five patients who required re-insertion of Tenckhoff catheter, four were for infective complications. A total of seven hernias developed in five (8%) of patients, mostly inguinal or umbilical near the Hassan port entry site. DISCUSSION With infection and hernia formation being the main contributors to failure of the procedure, actively addressing the entry site and areas predisposed to hernia formation, observing aseptic technique and meticulous attention to early signs of complications during follow-up are vital to improve success rates. The outcomes of the laparoscopic single-port insertion technique shows promise compared with conventional Tenckhoff catheter insertion techniques.
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Affiliation(s)
- Daniel Bunker
- Surgery Department, Dubbo Base Hospital, Dubbo, New South Wales, Australia
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Zhu W, Jiang C, Yan X, Sun C, Zhang M. The ureteroscope-assisted "Mini-Perc" technique of placement of peritoneal dialysis catheters with a 16-Fr Peel-Away sheath: 3-year results in 47 patients. Int Urol Nephrol 2012; 45:233-7. [PMID: 22821085 DOI: 10.1007/s11255-012-0229-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 06/12/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study was undertaken to evaluate the clinical feasibility, safety and effect of the ureteroscope-assisted "Mini-Perc" technique with a 16-Fr Peel-Away sheath for insertion of peritoneal dialysis catheters in end-stage renal disease (ESRD) patients. PATIENTS AND METHODS 47 consecutive ESRD patients underwent ureteroscope-assisted placement of peritoneal dialysis catheters via a 16-Fr Peel-Away sheath. Informed consent form was signed by patients under principle of voluntary. RESULTS The mean duration of the operation was 40 min (range, 21-75 min). Seven patients (14.9 %) experienced mechanical complications: catheter tip migration in 1 patient (2.1 %), slightly bloody ascites in 4 patients (8.5 %) and catheter-related peritonitis in 2 patients (4.3 %). Two catheters (4.3 %) were removed after renal transplantation. One patient (2.1 %) died from heart failure. One catheter (2.1 %) was explanted because of malfunction. After a mean follow-up time of 15 months (range, 2-36 months), 42 catheters are still functioning properly. CONCLUSIONS The ureteroscope-assisted "Mini-Perc" technique with a 16-Fr Peel-Away sheath is a simple, safe and effective method for placement of peritoneal dialysis catheters in ESRD patients.
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Affiliation(s)
- Wei Zhu
- Department of Nephrology, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, Jiangsu, People's Republic of China
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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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Oreopoulos DG, Tzamaloukas AH. Our war against bacteria in peritoneal dialysis, the last 40 years! Int Urol Nephrol 2009; 40:709-14. [PMID: 18443912 DOI: 10.1007/s11255-008-9392-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Challenges in pediatric peritoneal dialysis in Turkey. Int Urol Nephrol 2008; 40:1027-33. [PMID: 18770008 DOI: 10.1007/s11255-008-9451-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 08/02/2008] [Indexed: 10/21/2022]
Abstract
Chronic peritoneal dialysis (CPD) is the modality of choice for children with end-stage renal disease in Turkey. CPD was first instituted in 1989 in Turkish pediatric patients by using imported basic equipment and solutions since then the number of patients on CPD increased gradually. Parallel to the developments in the PD industry, in 2002, the Turkish Pediatric Nephrology Association established the Turkish Pediatric Peritoneal Dialysis (TUPEPD) Study Group to study peritoneal dialysis in children and adolescents. Today in Turkey, almost all of the PD equipment and PD solutions are available. Turkish pediatric nephrologists now have a significant experience with PD. Physicians, parents, and the children prefer to start with CPD because of its advantages, such as a more liberal social life and better school attendance.
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Statin therapy in peritoneal dialysis patients: effects beyond lipid lowering. Int Urol Nephrol 2007; 40:165-70. [DOI: 10.1007/s11255-007-9307-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 10/27/2007] [Indexed: 11/29/2022]
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