Laparoscope Is a Useful Tool for Reducing and Drawing off a Peritoneal Dialysis Catheter in Peritoneal Dialysis Patients

Laparoscopic observations of adhesions between peritoneal dialysis catheters and intraperitoneal organs: A retrospective, observational study

Laparoscopy provides extensive data for the decannulation of a peritoneal dialysis catheter and is being increasingly used to diagnose encapsulating peritoneal sclerosis. However, there are few reports on the methods of decannulation of peritoneal dialysis catheters. In this study, we examined the laparoscopic findings and postoperative complications of patients undergoing peritoneal dialysis catheter removal. A total of 119 laparoscopic decannulations of peritoneal dialysis catheters were performed between 2003 and 2018 at the Juntendo University Hospital and Juntendo University Nerima Hospital. Laparoscopy was performed during peritoneal dialysis catheter removal by a gastrointestinal surgeon. Patient characteristics such as age, sex, duration of peritoneal dialysis, history of peritonitis and age at the time of peritoneal dialysis termination were assessed. Of these 119 cases, 19 (16.0%) showed adhesion between the peritoneal dialysis catheter and intraperitoneal organs. There were 13 (10.9%) cases involving a tangled omentum, 4 (3.4%) cases involving the small intestine and 2 (1.7%) cases of adhesions extending from the bowels to the abdominal wall. No postoperative complications were associated with the laparoscopic surgery. In these cases, blind decannulation of the peritoneal dialysis catheter may result in injury to the gastrointestinal tract in patients with adhesions. Therefore, we need to pay attention to adhesions between peritoneal dialysis catheters and intraperitoneal organs, and laparoscopy could be a valuable tool in detecting such adhesions and ensuring patient safety.

Literature review: Combined therapy with peritoneal dialysis and hemodialysis as renal replacement therapy

Background

Peritoneal dialysis (PD) is the recommended renal replacement therapy for patients with end-stage kidney disease. Complementary hemodialysis (HD) once per week for PD patients can aid in achieving adequate dialysis and extend the duration of PD treatment. In Japan, this therapy is termed “combined therapy with PD and hemodialysis (combPDHD).” CombPDHD represents a treatment option for PD patients for whom adequate dialysis cannot be maintained. CombPDHD has been widely applied in Japanese PD patients; however, it is much less common outside of Japan. Clinical evidence, particularly regarding long-term prognosis and appropriate duration of treatment, remains insufficient.

Summary

CombPDHD will be required as an alternative for increasing the dose of PD under various conditions, such as a loss of residual kidney function (RKF) and peritoneal functional failure. The Japanese regimen for combPDHD involves 5 or 6 days of PD, combined with one weekly session of hemodialysis. According to some reports, the potential benefits of combPDHD are peritoneal rest with improved peritoneal function and delay in membrane deterioration. CombPDHD prevents peritoneal dysfunction and reduces cardiovascular complications by adjusting the fluid volume and improving renal anemia. Increased D/PCr indicates a deterioration in peritoneal function and is an independent risk factor for encapsulating peritoneal sclerosis (EPS). It is previously reported that no significant differences in combPDHD duration were observed between EPS and non-EPS groups. Laparoscopic findings involving patients with combPDHD revealed that there was a difference in abdominal wall degeneration depending on the intra-abdominal cavity of each case. Recently, prospective studies on long-term peritoneal function, survival, and hospitalization in combPDHD have been reported. However, reviews evaluating combPDHD long-term outcomes in multicenter and prospective studies are lacking.

Conclusion

It is difficult to continue PD alone with a declining RKF or when self-management is poor. Hence, combPDHD should be started to adjust the fluid volume, with adequate dialysis dose and peritoneal rest. This therapy is useful from a lifestyle viewpoint during the transition period from PD to HD and should not be continued indefinitely.

Multicenter laparoscopic evaluation of the peritoneum in peritoneal dialysis patients

Laparoscopic findings have been used to confirm peritoneal degenerations in peritoneal dialysis (PD) therapy. This study evaluated morphological changes in the peritoneum and their clinical relevance in patients undergoing PD. Laparoscopic findings at the rectovesical peritoneum were evaluated and scored using an imaging system at the time of PD catheter removal in this multicenter study. Angiogenesis evaluated by the vascular score (VS), color changes score (CCS), plaque score (PS), PD duration, history of peritonitis, dialysate/plasma creatinine (D/P Cr) levels, and age at PD termination were statistically analyzed. The VS of patients with PD duration more than 96 months was significantly decreased compared with that of the other patients and was negatively correlated with D/P Cr levels at PD termination. The CCS for patients with PD duration more than 96 months were significantly higher than those for the other patients and positively correlated with D/P Cr levels at PD termination. The PS of patients with recurring peritonitis were significantly higher than those of the other patients. Diminished vascularity and increased color changes in the peritoneum may be predictive of D/P Cr levels with peritoneal degradation. Laparoscopic evaluation of the abdominal cavity can provide detailed information about peritoneal injury.