A Modified Method in Laparoscopic Peritoneal Catheter Implantation: The Combination of Preperitoneal Tunneling and Pelvic Fixation

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.

Effects of a Novel Peritoneal Dialysis: The Open Versus Laparoscopic Preperitoneal Tunneling Technique

“…These findings may indicate that long-term catheter survival is better in the LA group. The combination of omentopexy and the preperitoneal tunneling method resulted in a longer catheter survival than each method alone (9,(23)(24)(25)(26)(27)(28). Despite this, we did not perform omental fixations, and our catheter survival rates seem to be sufficient according to the literature.…”

A Novel Technique for Laparoscopic Salvage of CAPD Catheter Malfunction and Migration: The Santosh-PGI Hanging Loop Technique

“…Laparoscopic salvage has definite advantages over open surgical procedures. Laparoscopic preperitoneal placement and pelvic fixation using extracorporeal knotting have been reported in an attempt to prevent catheter migration [ 10 ]. We report an innovative, easily performed technique of laparoscopic rescue of CAPD catheter malfunction due to wrapping by appendices epiploicae of sigmoid colon and catheter tip migration.…”

Laparoscopic peritoneal dialysis catheter implantations

“…Periton diyaliz kateterinin laparoskopik yerleştirilmesi, karın içindeki var olan bantların laparoskopik görüş altında açılmasına ve kateterin ucunun karın duvarında hazırlanmış tespit sütürünün içinden geçirilerek rahatça pelvis içine yerleştirilmesine olanak sağlamakta ve kateterin yer değiştirme oranlarını anlamlı şekilde azalmaktadır (10) . Kateterin askı dikişleri ile karın duvarına tespit edilmesi kateterin ucunun pelviste kalmasını sağlayarak omentumla sarılmasını da engellemektedir (11) . Laparoskopik olarak omentumun karın yan duvarına sabitlenmesi veya ovariopeksi uygulayan merkezler de bulunmaktadır (11,12) .…”

“…Kateterin askı dikişleri ile karın duvarına tespit edilmesi kateterin ucunun pelviste kalmasını sağlayarak omentumla sarılmasını da engellemektedir (11) . Laparoskopik olarak omentumun karın yan duvarına sabitlenmesi veya ovariopeksi uygulayan merkezler de bulunmaktadır (11,12) . İşlem sırasında göbek portundan girilen bir endoskopik doku tutucu ile omentum dışarı alınarak omentektomi rahat ve güvenli bir şekilde uygulanabilmektedir.…”