Evaluation of the effectiveness of prophylactic omentopexy during laparoscopic insertion of peritoneal dialysis catheter: a case-control clinical trial

INTRODUCTION

The laparoscopic omentopexy has been described for the prevention of peritoneal dialysis catheter obstruction due to omental wrapping of the catheter. As there are some controversies and limited data regarding the outcomes of prophylactic omentopexy, we designed a study to evaluate the efficacy of prophylactic omentopexy in preventing catheter dysfunction in patients undergoing laparoscopic catheter placement.

MATERIALS AND METHODS

In this randomized clinical trial, patients with end-stage renal disease during 3 months were divided into two groups of peritoneal dialysis catheter implants with and without omentopexy and subsequently evaluated regarding postoperative features.

RESULTS

A total of 43 patients were evaluated, including 22 undergoing prophylactic omentopexies. There was no significant difference among the baseline features of the patients. There was also no significant difference regarding postoperative features, including peritonitis, leakage, reoperation, need for catheter removal, and mortality.

CONCLUSION

Prophylactic omentopexy did not cause any significant differences in complications. In addition, there was no benefit for decreasing postoperative outflow obstruction due to omental wrapping following peritoneal dialysis catheter insertion.

When end-stage kidney disease complicates abdominal surgery

Patients receiving peritoneal dialysis (PD) encounter an increased risk for infection, bleeding, and PD fluid leakage after abdominal surgery. These complications may affect the future use of PD. Appropriate patient preparation may mitigate complications. Certain complications or procedures allow patients to remain on PD while others require transition to hemodialysis. We review the etiology and management of infection, bleeding, and PD fluid leakage associated with abdominal surgery as well as the relationship of specific abdominal procedures to continuing PD.

Laparoscopic Placement of Oreopoulos–Zellerman Catheters in CAPD Patients

Background

Continuous ambulatory peritoneal dialysis (CAPD) is widely accepted for the management of end-stage renal disease. Various techniques have been described for the insertion of peritoneal dialysis catheters. Lately, with the evolution of laparoscopic surgery, different laparoscopic techniques have also been presented, suggesting the technique is preferable to the open and percutaneous methods.

Objective

To introduce and evaluate a new laparoscopic technique for insertion of Oreopoulos–Zellerman catheters in CAPD patients.

Setting

The study was carried out in the First Department of Propaedeutic Surgery, Athens University Medical School, Hippokration Hospital.

Patients and Methods

Between November 2000 and March 2002, the technique was applied in 20 consecutive patients (mean age 62 years, range 54 – 70 years) with end-stage renal disease. During this technique, a 10-mm trocar is placed just below the umbilicus for the optics and a 5-mm trocar is placed in the right lower quadrant. With the help of a 10-mm trocar, a tunnel is formed in the standard paramedian position on the left side, 2 – 3 cm below the plane of the umbilicus, for the insertion of the peritoneal catheter. A laparoscopic needle (GraNee needle; R-Med, Oregon, Ohio, USA) is used for the closure of the 10-mm trocar-induced peritoneal and fascia defect using a purse-string suture. The catheter is advanced into the abdomen under direct vision and guided toward the Douglas pouch. The subcutaneous tunnel and the patency test of the catheter are performed as the last main steps in our procedure. One surgeon undertook all procedures.

Results

All procedures were completed laparoscopically. The mean operative time was 30 minutes (range 25 – 40 minutes). There was no intraoperative complication or surgical mortality. One patient developed leakage at the catheter exit site 3 days after surgery; it was corrected under local anesthesia. During a mean follow-up time of 17 months (range 12 – 28 months), 1 patient required catheter removal due to fungal peritonitis.

Conclusion

Laparoscopic insertion of the Oreopoulos–Zellerman catheter is a simple, quick, and safe method. We believe future experience will encourage the laparoscopic technique as the method of choice.

The Self-Locating Catheter: Clinical Experience and Follow-Up

Background

The self-locating catheter invented by Nicola Di Paolo has been used increasingly in Italy and elsewhere since 1994, with about a thousand patients currently implanted every year. Twelve grams of tungsten inserted into the tip of the conventional Tenckhoff catheter during extrusion does not significantly change its form, but suffices to keep the tip firmly in the Douglas cavity.

Objective

The aim of the present study was to confirm our preliminary results in a large population of peritoneal dialysis patients.

Setting

16 Italian nephrology departments.

Results

In addition to confirming the validity of the new catheter, the present results show that patients with the new catheter have fewer episodes of peritonitis, tunnel infection, cuff extrusion, catheter malfunction, obstruction, and leakage.

Conclusion

The present multicenter control study confirms preliminary results and demonstrates that complications of peritoneal dialysis, such as cuff extrusion, infection, peritonitis, early leakage, and obstruction, are statistically less frequent in patients with self-locating catheters than in patients with classic Tenckhoff catheters.

Malfunctioning Peritoneal Dialysis Catheter and Accompanying Surgical Pathology Repaired by Laparoscopic Surgery

♦ Objectives

To review the laparoscopic salvaging of malfunctioning peritoneal dialysis (PD) catheters, and to present our experience with laparoscopic repair of dysfunctional Tenckhoff catheters and the treatment of accompanying surgical pathologies.

♦ Design

Malfunctioning peritoneal catheters were repaired using laparoscopic rescue techniques. Accompanying surgical problems were treated in the same operation. The effectiveness of these approaches was validated by comparison with other remedial techniques described previously.

♦ Patients

Malfunctioning PD catheters were salvaged by laparoscopic surgery in 8 patients, and accompanying surgical problems were treated in the same operation in 3 of the 8 patients.

♦ Main Outcome Measures

Outcome was measured by the successful return to adequate PD and effective treatment of surgical problems.

♦ Results

Eight patient studies show laparoscopic correction of malfunctioning catheters and the treatment of accompanying surgical pathologies with the return to successful PD.

♦ Conclusion

The salvaging of malfunctioning PD catheters by laparoscopic surgery is an ideal method. This procedure permits simultaneous identification and correction of other surgical problems that could otherwise complicate dialysis therapy.

Minilaparoscopic Extraperitoneal Tunneling with Omentopexy: A New Technique for CAPD Catheter Placement

Background

Continuous ambulatory peritoneal dialysis (CAPD) is an effective form of treatment for patients with end-stage renal disease. Open insertion of peritoneal dialysis (PD) catheters is the standard surgical technique, but it is associated with a relatively high incidence of catheter-related problems. To overcome these problems, different laparoscopic techniques have been presented, being preferable to the open and percutaneous methods.

Objective

To introduce and evaluate the efficiency of laparoscopic omental fixation and extraperitoneal placement of the cuff–coil part (the straight portion) of the catheter to prevent catheter tip migration, pericatheter leakage, severe abdominal pain, and the obstruction caused by omental wrapping.

Setting

The study was carried out in the General Surgery Department, Akdeniz University Medical School, in Turkey.

Patients and Methods

Between November 2001 and March 2005, the technique was applied in 44 consecutive patients (mean age 51.6 years, range 18 – 67 years) with end-stage renal disease. During this laparoscopic technique, the omentum was first fixed onto the parietal peritoneum, and then the catheter was introduced through the subumbilical trocar site into the posterior rectus compartment and advanced toward the symphysis pubis. The catheter was then inserted into the abdominal cavity, passing the peritoneal opening, which was prepared before catheter insertion. The straight portion of the catheter was located into the extraperitoneal area of the anterior abdominal wall. The curled end, which contains the side-holes of the catheter, was placed into the true pelvis. Catheter position and patency were verified under direct vision using a 2 mm telescope.

Results

All procedures were completed laparoscopically. Operating time ranged between 40 and 100 minutes (median 52 minutes). There was no intraoperative complication or surgical mortality. Peritoneal dialysis was initiated within 15 – 24 hours after catheter implantation. After a median follow-up period of 17.4 months (range 1 – 38 months), early exit-site infection occurred in 1 of 44 patients. All catheters functioned well postoperatively. There was no pain during CAPD.

Conclusion

This new laparoscopic technique using an extraperitoneal approach with omentopexy for PD catheter placement could prove extremely useful for preventing catheter malfunction caused by catheter tip migration, pericatheter leakage, omental wrapping, and periodic catheter movement that causes abdominal pain in CAPD.

The Self-Locating Catheter: Clinical Evaluation and Comparison with the Tenckhoff Catheter

Background

Peritoneal catheter displacement appears to be related to various causes including omental attachment, bowel contractions, peritoneal adhesions, and the catheter floating in the dialysis fluid. In order to prevent this complication, which can impair peritoneal dialysis efficacy, Di Paolo et al. designed a “self-locating catheter” (SLC) that is similar to the Tenckhoff catheter (TC) and includes a small tungsten cylinder (weight 12 g) at the distal end (Di Paolo N, et al. The self positioning catheter. Proceedings of the VII Italian Congress on Peritoneal Dialysis. Milan: Wichtig Editore, 1993:539–42). The weight of the tip prevents the catheter from floating and migrating by gravitation toward the Douglas cavity.

Objective

Starting in 1996, we implanted SLC in 15 continuous ambulatory peritoneal dialysis patients. The aim of our study was to compare the ratio of migration and other catheter-related complications between patients with SLC (196 patient-months) and 13 patients with conventional straight TC (295 patient-months).

Results

Peritonitis ratio, catheter complication rate, dialysate inflow and outflow, and weekly creatinine clearance were similar in the two groups of patients. The incidence of catheter displacement was significantly higher ( p = 0.0349) in the TC group than in the SLC group (4 vs 0).

Conclusion

In our experience, the SLC seems to be useful in preventing catheter migration by continuous gravitation of its extremity toward the pelvic cavity.

A New Self-Locating Peritoneal Catheter

Objective

Peritoneal catheters often become dislocated, and this may lead to malfunction. Since it is not usually possible to bring them back into their correct position, they must be replaced. With the aim of preventing this complication, we designed a new catheter.

Design

The new catheter has the same form as the Tenckhoff catheter except for a small increase in external diameter of the last 2 cm, made possible by the high specific weight of a small12-g tungsten cylinder incorporated in the Silasticat the abdominal end. The new catheter may be inserted by a percutaneous technique.

Setting

University hospitals of Sienaand Perugia, Italy.

Patients

In the last three years, 32 of these catheters have been implanted for a total experience of 468 patientmonths. Their position was checked on insertion and every two months thereafter by radiography; 26 Tenckhoff catheters (415 patient-months) were studied at the same time. Insertion was performed surgically and by a percutaneous method. The frequency of cuff extrusion, exit-site infections, leakage, and peritoneal infection were noted, together with peritoneal function, which was evaluated by KTN and weekly creatinine clearance one month after catheter insertion; the tests were repeated when dislocation occurred and at the end of the trial.

Results

No dislocations occurred with the self-locating catheters, whereas nine dislocations occurred in control patients (p = 0.0003). There were no significant differences with respect to controls for cuff extrusion, exit-site infections, leakage, peritoneal infection, and peritoneal function.

Conclusions

The presence of a small weight at the catheter tip prevents displacement completely, keeping the intraperitoneal part of the catheter in place.

Efficiency and safety of using a peritoneal dialysis catheter weighted with a stainless steel ballast : the Limousin experience

Objective: To assess the recurrence of PD catheter migration after the introduction of a walnut ballast. Materials and Methods: Retrospective study from 1999 to 2014 of PD patients followed in Limousin. Were compared two groups: ballast group (patients who benefited from the establishment of stainless steel ballast at the intraperitoneal catheter extremity) with 26 patients and control group with 204 patients. The primary endpoint was the occurrence of an episode catheter’s migration after ballast’s establishment. Secondary objectives were (i) to determine the causal factors leading to the catheter weighting, (ii) to ensure the safety of the procedure on the following criteria: infectious complications, mechanicals complications, epurations criteria, and catheter’s survival. Results: More than one year after the implementation of the ballast, no recurrent migration was observed in 86.6% of cases. It wasn’t found an increased risk of infections (OR = 0.5, 95% CI [0.22, 1.13]) or mechanical complications (OR = 1.77- 95% CI [0.77, 4.05]) between the two groups. The adequation criteria were similar: KT / V total : 2.37 in the control group and 2.28 in the ballast group (p = 0.63). The survival of the ballast catheter was comparable among the two groups (p = 0.983). Three causal factors that led to the ballast were identified: automated peritoneal dialysis (APD) (OR = 0.38, 95% CI [0.16, 0.9]), the failure from the first use of the catheter (OR = 19.48, CI 95 % [7.67, 49.48]) and the incarceration of the omentum (OR = 15.84, 95% CI [5.81, 43.21]). Conclusion: The ballast used in these study appears to prevent recurrence of migration, without any impact in terms of infectious or mechanical complications, or on the dialysis criteria or on catheter’s survival. However this catheter does currently not have an EC authorization

The Self-Locating Catheter: Review and Cost Analysis

The self-locating catheter invented by Nicola Di Paolo has been increasingly used in Italy and elsewhere since 1994, with about a thousand patients currently implanted every year. Twelve grams of tungsten inserted in the tip of the conventional Tenckhoff catheter during extrusion do not significantly change its form, but suffice to keep the tip firmly in the Douglas cavity.

The validity of the new catheter is confirmed by a multicentric controlled study in a large population of peritoneal dialysis patients. This trial showed that patients with the new catheter have fewer episodes of peritonitis, tunnel infection, cuff extrusion, catheter malfunction, obstruction and leakage.

This paper outlines the present situation and reports a comparative analysis of the costs of Tenckhoff and self-locating catheters.

Analysis of Hospitalization after Peritoneal Dialysis Catheter Implantation

♦

BACKGROUND

Implantation of the peritoneal dialysis catheter (PDC), usually an elective procedure, may necessitate unexpected hospitalization and even transfer to intensive care due to the multiple comorbidities and inherent instability of the end-stage renal disease patient. Information on hospitalization after PDC implantation is limited and details about the reason for hospitalization are lacking. ♦

METHODS

We performed a cohort study in consecutive patients who underwent PDC implantation at a single institution from September 2007 to September 2013. Clinical characteristics of enrolled patients, technique of the implantation procedure, and all-cause unexpected hospitalization and morbidity within 14 days after implantation were analyzed. ♦

RESULTS

Excluding the patients with pre-arranged admission, a total of 246 patients receiving 252 PDC implantations during the 6 years were studied. After 39 procedures (15.5%), patients had an unexpected hospital stay or re-admission due to operative complications (33.3%), worsening of disease (35.9%), or a single-night hospital stay for observation (30.8%). Compared with discharged patients, the patients with unexpected hospitalization were older (p = 0.001), experienced higher rates of previous episodes of heart failure (p = 0.006) and heart disease (p < 0.001), had more use of general anesthesia (GA) (p = 0.046), underwent more added procedures during the implantation (p = 0.02), and had more episodes of flow obstruction and peritonitis after implantation (p = 0.012 and p < 0.001, respectively). Using a multivariable logistic regression, we showed that age, cardiac morbidity, use of general anesthesia, PDC flow problems and peritonitis after implantation were independent predictors of all-cause unexpected hospitalization. ♦

CONCLUSIONS

For the first time, our study analyzed the predictors of unplanned hospitalization after PDC implantation and identified the salient risk factors. Increased focus to identify patients at greatest risk for hospitalization, evaluation of processes of care, and implementation of preventive strategies may be helpful to reduce unplanned hospitalization after catheter insertion.

Comparison between the fixation of peritoneal dialysis catheters to the peritoneal wall and the conventional placement technique: clinical experience and follow-up of a new implant technique for peritoneal dialysis catheters

Peritoneal dialysis (PD) catheters often become severely dislocated, which may lead to malfunction. With the aim of preventing this complication, we have developed a simple method of fixing the catheter downwards in the peritoneal cavity (fixation technique), a technique that does not require a laparoscope. Sixteen patients were implanted using the conventional placement technique and 25 patients were implanted using the fixation technique. The location of the catheter tip was classified from grade 1 (downward, normal) to 5 (dislocated). The frequency of dislocation (defined as the extended time and/or decrease in volume when draining the PD solution) was measured for both the fixation technique and conventional placement technique. There was a significant difference in grade between the fixation technique (2.72 ± 1.01) and conventional technique (3.92 ± 1.31). The time until first dislocation was significantly different between the fixation technique (59.3 ± 48.1 days) and conventional technique (8.8 ± 14.6 days). The time until any dislocation was significantly different between the fixation technique (69.2 ± 41.9 days) and conventional technique (12.9 ± 13.7 days). Complications were not significantly different between the fixation technique and conventional technique. The fixation technique appears to be simple, safe, and useful for preventing severe dislocation and for lengthening the time until dislocation in PD patients.

Our long-term results of Tenckhoff peritoneal dialysis catheters placement via laparoscopic preperitoneal tunneling technique

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.

One-Port Laparoscopic Technique for Placement of Tenckhoff Peritoneal Dialysis Catheters: Report of Seventy-Nine Procedures

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.

Omental Folding: A Novel Laparoscopic Technique for Salvaging Peritoneal Dialysis Catheters

Background

Omental wrap is a common cause of catheter obstruction. Current laparoscopic techniques for correcting obstruction include omentopexy and omentectomy. This study evaluates the efficacy of a new laparoscopic technique for revision of obstructed peritoneal dialysis catheters.

Methods

Between November 2005 and November 2006, the technique was applied in 18 patients (6 female, 12 male; median age 50 years, range 16 – 73 years) on continuous ambulatory peritoneal dialysis with catheter malfunction secondary to omental wrap. Pneumoperitoneum was induced under general anesthesia. Three ports were inserted. The catheter was released from the omentum and repositioned in the pelvis. The omentum was then folded onto itself in a cephalad direction using silk sutures. This shortened the omentum. The risk of catheter migration was minimized with a polypropylene sling passed through the abdominal wall and around the catheter, then knotted subcutaneously. The sling allowed catheter removal without a new laparoscopy. The outcomes were prospectively evaluated.

Results

Median operating time was 90 minutes (range 35 – 160 minutes). Adhesiolysis was performed in 4 patients: 1 patient had port-site leakage of dialysate, which settled with abdominal rest; 1 patient had bleeding during adhesiolysis and laparoscopic hemostasis was successful; 1 patient had recurrent catheter obstruction 2 weeks post-operatively and was converted to hemodialysis; and 1 patient had recurrent malfunction secondary to small bowel wrap after 5.5 months; re-salvage was successful. The success rate of the first salvage procedure was 89%(16/18). The catheters were still functioning after a mean follow-up of 16.5 ± 6.3 months (range 0.5 – 24 months). The 1-year catheter survival rate was 83.3%.

Conclusions

Omental folding is a safe and effective technique for salvaging peritoneal dialysis catheters.

Laparoscopic-assisted peritoneal dialysis catheter placement: a microinvasive technique

BACKGROUND

Peritoneal dialysis is an alternate form of dialysis for patients with end-stage renal disease (ESRD). Although not as widely used as hemodialysis, peritoneal dialysis (PD) has clear advantages, especially those related to patient satisfaction and simplicity. The purpose of our study was to describe and look at the results of a microinvasive technique for placement of peritoneal dialysis catheters under laparoscopy.

METHODS

From August 2003 to January 2006, 12 patients with ESRD underwent laparoscopic-assisted peritoneal dialysis (LAPD) catheter placement with the microinvasive technique at our institution. Data collected included age, gender, underlying renal disease, and length of operation. Followup was completed for all patients (at least 6 months) and catheter-related morbidity and mortality were also analyzed.

RESULTS

There were 13 procedures performed (one patient had LAPD catheter placement twice). The average age was 45 years and the most common cause of ESRD was uncontrolled arterial hypertension. Procedural time averaged 33.6 min (range = 24-50 min). Peritoneal dialysis was introduced two weeks after the procedure and no dialysate leaks were observed. There were two catheter-related morbidities; both were catheter exit-site abscesses, one managed surgically with removal of the PD catheter and the other managed conservatively with culture-sensitive antimicrobials. Patient satisfaction was beyond acceptable in 92% of the patients (12 of 13). Average longevity of the catheter was 61 weeks (427 days). There were no mortalities.

CONCLUSION

LAPD catheter placement is an easy technique with acceptable catheter longevity and minimal morbidity. The microinvasive technique leads to better patient satisfaction and cosmetic outcome without affecting its function. Therefore, we believe that by promoting microinvasive LAPD catheter placement, PD will gain more acceptance among doctors and patients.

Videolaparoscopy as rescue therapy and placement of peritoneal dialysis catheters: a thirty-two case single centre experience

BACKGROUND

Malfunction of the peritoneal catheter is a frequent complication in peritoneal dialysis (PD). Videolaparoscopy is a minimal invasive technique that allows rescue therapy of malfunctioning catheters and consecutive immediate resumption of PD. Furthermore, Tenckhoff catheters can be safely positioned in patients with previous abdominal surgery. We analysed the clinical diagnosis, videolaparoscopic treatment and the outcome of PD patients on whom videolaparoscopic interventions had been performed at our centre.

METHODS

Thirty-two cases of videolaparoscopic interventions were performed for salvage of malfunctioning peritoneal catheters, implantation and abdominal surgical interventions in 25 PD patients. The videolaparoscope was inserted through a mini-laparotomy site of 15 mm diameter which was closed with purse-string sutures at the end of the intervention.

RESULTS

Videolaparoscopy was used in 21 cases of catheter malfunction mostly due to omental wrapping (12 cases) and dislocation (five cases). In eight patients with previous surgical abdominal interventions, laparoscopic placement of the PD catheter was performed. In two cases the gall bladder was removed. One case of intestinal occlusion was evaluated laparoscopically in an attempt to minimize invasive surgery. Leakage of the peritoneal fluid presented the only complication caused by insufficient closure of one mini-laparotomy site. Minimal follow-up time of rescued catheters was 5 months. Videolaparoscopy prolonged PD catheter function by a median of 163 days (range 5-1469 days).

CONCLUSIONS

Videolaparoscopy prolongs peritoneal catheter survival by treating directly the causes of malfunction. In patients with preceding abdominal interventions, the PD catheter can be placed safely even in cases necessitating surgical preparation like adhesiolysis.

Technique for laparoscopy-assisted complicated peritoneal dialysis catheter placement

Peritoneal dialysis is widely accepted for the chronic management of end-stage renal disease. Especially in patients suspected of having intra-abdominal adhesions, the application of laparoscopic surgical techniques has significantly changed our surgical approach to dialysis catheter placement. The blind placement of peritoneal dialysis catheters in this patient group can be both dangerous, because of the higher risk of bowel injuries, and unsuccessful, because of immediate catheter misplacement or entrapment. We describe a relatively simple step-by-step approach to laparoscopy-assisted peritoneal dialysis catheter placement with omentectomy in these more complicated cases.

Uso da laparoscopia no manejo das complicações relacionadas ao cateter de diálise peritoneal

O presente estudo tem como objetivo analisar os métodos utilizados para o tratamento das complicações relacionadas ao cateter de diálise peritoneal , avaliando-se o uso das vias aberta e laparoscópica. Vinte pacientes apresentaram 35 complicações relacionadas ao cateter de diálise (obstrução 60%, peritonite 34,3% e infecção do trajeto 5,7%) e foram tratados cirurgicamente. Para o tratamento das complicações, foram realizados 22 procedimentos por via aberta (laparotomia) e 13 por via laparoscópica. Através do método laparoscópico, foi possível desobstruir e manter o cateter em 80% dos cateteres obstruídos, ao passo que 100% foram trocados ou retirados quando a via aberta foi utilizada. O tempo necessário para reutilização completa do mesmo após o procedimento foi maior pelo método aberto. Os dados apresentados sugerem que a laparoscopia é um método eficaz como opção terapêutica para o tratamento das complicações relacionadas ao cateter de diálise peritoneal, pela visualização direta da cavidade peritoneal e possibilidade de reposicionamento ou desobstrução do mesmo, não sendo portanto necessária a sua troca e diminuindo também o tempo necessário para reutilização completa do cateter.

A practical approach to laparoscopic surgery for malfunctioning peritoneal dialysis catheters

Peritoneal dialysis is widely accepted for the chronic management of end-stage renal disease but is associated with as high as a 70% complication rate including a significant problem with peritoneal dialysis catheter flow obstruction. The application of laparoscopic surgical techniques has revolutionized the surgical approach to peritoneal dialysis catheter-related dysfunction. However, the specific laparoscopic surgical technique varied among the reported literature. This lack of a standard laparoscopic surgical approach to obstructed peritoneal dialysis catheters prompted us to review and compare our specific technique and experience in 17 patients with 10 recent reported series. We specifically examined for insufflation techniques, access port placements and closures, timing postoperatively for reinstituting peritoneal dialysis, wound complications, and overall long-term success rates for peritoneal dialysis catheter salvage.